Screening for Campylobacter pyloridis in patients with upper dyspepsia and the relation to inflammation of the human gastric antrum

Campylobacter pyloridis, a recently detected microorganism, was isolated from gastric antral mucosa in 58% of 119 consecutive patients with upper dyspepsia. There was a highly significant correlation between the presence of Campylobacter pyloridis and antral inflammation and a close relation to prepyloric and duodenal ulcer. There was no significant correlation with the severity or type of inflammation. This microorganism, which seems to be as common in Denmark as in other parts of the world, is considered a possible cause of gastroduodenal disease.     

Prospective controlled vagotomy trial for duodenal ulcer. Results after 11-15 years.

A prospective, randomized, controlled trial was conducted to compare truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy (PCV) as elective treatment for duodenal ulcer. Between 11 and 15 years after operation, 248 patients were available for study of the recurrent ulceration rate by a life table method, and 197 patients could be studied with regard to postvagotomy symptoms. The recurrent ulcer rates were 28.5% for TV, 37.4% for SV, and 39.3% for PCV. These differences were not statistically significant. The incidence of severe postvagotomy symptoms was as follows: dyspepsia, 18.4% for TV, 20.5% for SV, 8.6% for PCV; dumping, 5.9% for TV, 19.6% for SV, 2.2% for PCV; diarrhea, 9.8% for TV, 11.8% for SV, 4.4% for PCV. The incidence of severe dumping was significantly less frequent among the PCV patients than the SV group. The differences did not reach statistical significance in any of the other groups. There was no significant difference in the Visick gradings among the three groups either before or after treatment of the failures. About two thirds of the patients in each group were finally satisfied with their operation, often after second operations or prolonged medical treatment. It is concluded that none of the three forms of vagotomy can be recommended as the standard operative treatment of duodenal ulceration.     

A report of iris neovascularization: an indication for carotid endarterectomy

The combined use of goniophotocoagulation and carotid endarterectomy may be an important mode of treatment of iris neovascularization caused by carotid insufficiency. Carotid operation alone in cases of iris neovascularization has not been successful in controlling the concomitant or ensuing neovascular glaucoma. When more severe symptoms of carotid occlusion occur, such as transient ischemic attacks or visual loss, it may be too late to reverse the damage of neovascular glaucoma. In this case report, early detection of the iris neovascularization, goniophotocoagulation, and carotid operation were successful in the prevention of neovascular glaucoma and blindness.     

Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery

Addition of fentanyl to bupivacaine administered for spinal anesthesia for cesarean delivery was evaluated in 56 ASA physical status 1 term parturients. Preservative-free saline was added to 0, 2.5, 5, 6.25, 12.5, 25, 37.5, or 50 micrograms fentanyl to make a 1 ml total volume, which was injected intrathecally prior to bupivacaine in a double-blind, randomized fashion. Vital signs, sensory level, motor block, pain score, and side effects were recorded every 2 min for the first 12 min and then at 15, 30, 45, and 60 min and at 30-min intervals until the patient complained of pain. At delivery maternal vein, umbilical artery, and umbilical vein blood gases were obtained. Apgar scores at 1 and 5 min were recorded. Early Neonatal Neurobehavioral Scales (ENNS) were performed on days 1 and 2. Side effects and opioid requirements were recorded for the first 24 h. All of the patients in the control group reported a pain score greater than 0 during surgery and 67% required intraoperative opioids. None of the patients who received greater than or equal to 6.25 micrograms fentanyl required intraoperative opioids. Complete analgesia (time from injection to first report of pain) lasted 33.7 +/- 30.8 min (mean +/- SD) in the control group and increased to 130 +/- 30 min (P less than 0.05) with addition of 6.25 micrograms fentanyl. Duration of effective analgesia (time from injection to first parenteral opioid) was 71.8 +/- 43.2 min in the control group and increased (P less than 0.05) to 192 +/- 74.9 min with addition of 6.25 micrograms fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment arms summarizing analysis of 220 high-grade glioma studies

Large phase III studies have identified limited survival benefits with chemotherapy in high-grade glioma. However, numerous clinical trials have been published previously with smaller patient numbers and no control groups. A small positive effect could be missed this way, resulting in premature rejection of possible beneficial treatment. In order to perform a treatment arm summarizing analysis (TASA), a database was created summarizing treatments published between January 1976 and June 2002. In this database, one record represents a cohort of patients treated in the same way. Various patient cohort characteristics such as median age, and outcome measures including median overall survival times (mOS), were documented. Two-hundred and twenty publications were documented with a total number of 17,213 cases treated in 337 treatment groups. There was a statistically significant relationship between the distribution of histological grades (p<0.001) and the outcome, and a better outcome in younger patient populations (p<0.01). However, the known influence of the median Karnowsky performance scale could not be confirmed in this database. The extent of surgery showed a positive influence only when excluding relapse studies, while the positive effect of radiation was clear in all subgroups (p<0.05). Clinical studies that included nitrosurea in the treatment had a significantly better outcome than those with platinum drugs or without chemotherapy. We conclude that TASA, representing a novel way to perform a meta-analysis, is valid since it confirms the known treatment effects and, therefore, has the potential to provide new insights by combining information from different clinical treatment studies.     

Anticoagulation therapy in patients with chronic atrial fibrillation: a retrospective claims data analysis

OBJECTIVES: This study assessed the risk of thrombo embolic events and bleeding complications among atrial fibrillation patients. METHODS: A cohort of patients with chronic non-valvular atrial fibrillation were identified from medical claims (diagnosis codes 427.31 and 427.32). Subjects were identified from 1 January 1998-31 December 2000 and were continuously enrolled for 6 months prior to the first occurring atrial fibrillation medical claim. Cox proportional hazards analysis with time varying covariates was used for the event analysis. RESULTS: Of 6764 subjects retained for analysis, 3541 (52.4%) were exposed to warfarin. Adjusting for baseline characteristics, warfarin exposure was associated with lower likelihood of an arterial thromboembolic event compared to no exposure (HR: 0.710, CI: 0.540-0.934). No benefit was found in the use of warfarin in the prevention of intracranial events (HR: 1.119, CI: 0.929-1.349). Use of warfarin increased the risk of minor bleeding events (HR: 3.600, CI: 2.537-5.109), and all bleeding events (HR: 1.502, CI: 1.289-1.749). CONCLUSIONS: The risk of arterial thromboembolic events was associated with warfarin exposure as expected. An increase in the risk of minor and total bleeding events among patients treated with warfarin was observed. The results of this study suggest that there may be a gap between the clinical trial and coagulation clinic performance of warfarin in reducing the risk of thromboembolic events versus what is achievable in general practice.     

Platelet adherence and detachment: a flow study with a series of hydroxyethyl methacrylate-ethyl methacrylate copolymers using video microscopy

The adhesion and detachment of platelets were studied on glass coatings of a series of copolymers of hydroxyethyl methacrylate (HEMA) and ethyl methacrylate (EMA). Observations of the interactions of mepacrine labelled washed platelets with these surfaces from a flowing (500 s-1 wall shear rate) suspension in Tyrode's solution containing albumin and red cells were made with epifluorescent video microscopy (EVM). Total platelet adhesion, including platelets which adhere on first contact and platelets which attach temporarily before adhesion, and the number of detaching platelets were minimal for the 0 and 20% EMA copolymers, reached a maximum for the 50% EMA copolymer and showed reduced values for the 80% and 100% EMA copolymers. For the 50, 80, and 100% EMA copolymers, the adhesion values expressed, as a percentage of total contacting platelets, were not different. Albumin adsorption to these copolymers shows a continuous increase from the 0% to the 100% EMA copolymer. It is likely that the peak in platelet adhesion at the 50% EMA composition is related to: low protein adsorption on the 0 and 20% EMA copolymers, too little albumin adsorption to block adhesion on the 50% EMA copolymer, and full-scale blocking on the 80 and 100% EMA copolymers due to greater albumin adsorption.