Association of Helicobacter pylori genotype with gastroesophageal reflux disease and other upper gastrointestinal diseases

OBJECTIVE: Helicobacter pylori (H. pylori) is a recognized pathogen, but it may also have a protective effect for gastroesophageal reflux disease (GERD). We compared the prevalence of potential virulence factors (cagA, cagE, vacA genotypes) in GERD to other upper gastrointestinal diseases and controls. METHODS: A total of 405 patients underwent gastroscopy with H. pylori isolation and serum testing. Patient diagnostic subgroups were prospectively defined. Genotypes were determined by amplification using polymerase chain reaction. CagA antibodies were determined by western blot, enzyme-linked immunosorbent, and flow microsphere immunofluorescent assays. RESULTS: Patients were grouped as follows: nonulcer dyspepsia (26%), GERD (20%), gastric ulcer (17%), duodenal ulcer (12%), gastric cancer (6%), or controls (19%). The cagA gene was present in 94-97% of subjects in all categories, but the cagA antibody was less prevalent in nonulcer dyspepsia (69%, 95% CI: 48-86%, p = 0.02) and GERD (69%, CI: 39-91%, p < 0.05) than in those with gastroduodenal pathology including gastric ulcer, duodenal ulcer, and gastric cancer (92%, CI: 81-98%). The cagE gene and vacA S1 genotype were more frequent in patients with gastroduodenal pathology (p < 0.01). GERD was associated with a significantly lower rate of vacA S1 genotype than controls (29% (CI: 10-56%) versus 80% (CI: 59-93%), p < 0.01). The vacA S1 genotype was associated with the presence of cagA antibodies. CONCLUSIONS: The cagE and vacA S1 genotypes are more prevalent in patients with peptic ulcer or gastric cancer, suggesting a potential function in virulence for these genes. However, the vacA S1 genotype was also more prevalent in controls than GERD, suggesting a potential protective effect against GERD.     

Plasma membrane glycoproteins of cultured rheumatoid synovial fibroblasts

Fibroblast cultures were started from synovial tissue samples of 12 rheumatoid arthritic, 9 non-rheumatoid synovitic and 6 control patients. External galactose units of plasma membrane glycoproteins of confluent cells were labelled using the galactose oxidase-tritiated borohydride method. These surface-labelled cells were analyzed for possible differences in their glycoproteins by electrophoresis in SDS-containing polyacrylamide gradient gels. Total cell lysates were separated into 50-60 polypeptide bands. Fluorography of the gels revealed about 20 labelled plasma membrane glycoproteins. Some strain-specific differences were detected between the samples in all the groups, but no correlation with rheumatoid arthritis could be demonstrated.     

Horton's disease in elderly patients aged over 75: clinical course, complications of corticotherapy. Comparative study of 164 patients. Towards a reduced initial dose

PURPOSE: Our study compares clinical and therapeutic courses (corticosteroid response, corticosteroid amount, complications) in people with giant cell arteritis before and over 75 years, during the first year of treatment. METHODS: A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg intravenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of prednisone, or 0.7 mg/kg/d of prednisone without the bolus. RESULTS: Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2; NS). Corticosteroid load was slightly lower in the elderly group (cumulative dose of corticosteroids during the first year of treatment 5.2 g vs 5.8 g; P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies, mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01), in spite of a limited mean follow-up period (10.7 months). CONCLUSION: Even if steroid response was identical in the therapeutic course of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-sparing effect, new studies are necessary to evaluate a reduced initial dosage of corticosteroids.     

ACR Appropriateness Criteria® Radiologic Management of Thoracic Nodules and Masses

Pulmonary and mediastinal masses represent a wide range of pathologic processes with very different treatment options. Although advances in imaging (such as PET and high-resolution CT) help in many cases with the differential diagnosis of thoracic pathology, tissue samples are frequently needed to determine the best management for patients presenting with thoracic masses. There are many options for obtaining tissue samples, each of which has its own set of benefits and drawbacks. The purposes of this report are to present the most current evidence regarding biopsies of thoracic nodules and masses and to present the most appropriate options for select common clinical scenarios. The ACR Appropriateness Criteria(?) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

Home-based zoledronic acid infusion therapy in patients with solid tumours: compliance and patient–nurse satisfaction

Purpose

This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL).

Methods

This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa®, 15-min i.v., every 3–4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points.

Results

Physician participation rate was 56.5 % (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30–95); M/F, 40/60; ECOG-PS 0 or 1, 78.6 %;and primary tumour site, breast (55.2 %), prostate (28.4 %), lung (7.2 %) or other (9.4 %). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9 %; ease of infusion, 96.7 %; patient–nurse relationship, 97.5 %; and relationship with hospital staff, 73 %. Patient satisfaction was also very high (95.3 %). The main reasons were quality of the nurse–patient relationship (57.6 %), less travel/waiting (68.8 %), home environment (52.9 %) and less disruption to daily routine (36.6 %). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6 %. The incidence of osteonecrosis of the jaw was 0.6 % and of fractures, 0.2 %. Practitioner compliance with best practice was 76.7–83.7 % for recommended and/or tolerated dosage, 73 % for dental hygiene checks at inclusion and 48–56 % thereafter, 66 % for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation.

Conclusions

Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged.     

Conservative treatment of bladder epitheliomas by partial cystectomy and iridium-192 curietherapy

From 1971 to 1979, 55 patients were treated for bladder cancer at the Henri-Mondor Hospital using a treatment protocol combining low dose pre-operative external beam radiation followed by iliac node dissection, limited partial cystectomy (or sometimes for T1 tumors, a trans-urethral resection) and curietherapy with iridium 192. The 5 year disease free survival was 37/55 (67%). The rate of local recurrences plus second tumors within the bladder was 16% (9/55). These results are compared with other conservative modalities of treatment of bladder cancer.     

Inapparent genital herpes simplex infection in women attending a venereal disease clinic

The purpose of this study was to determine the prevalence of asymptomatic genital infection with herpes simplex virus in women attending a venereal disease clinic in Puerto Rico. Genital samples were obtained from 123 consecutively enrolled patients. Vero cells were used for viral isolation; isolates demonstrating cytopathic effect were stored at -70 C and were typed by use of monoclonal antibodies. Herpes simplex virus was isolated from six patients, three of whom were free of any possible complaint that might be associated with a genital herpes virus infection. One patient was diagnosed as having herpetic cervicitis, and the remaining two were clinically diagnosed as well as laboratory confirmed cases of genital herpes. Virus isolated from all six women was identified as herpes simplex virus type 2. Thus the prevalence of laboratory confirmed genital herpes infection in women attending this clinic was 4.9% (6/123). Inapparent virus infection was detected in 2.5% (3/120) of the patients.     

Xeroderma pigmentosum fibroblasts are more sensitive to asbestos fibers than are normal human fibroblasts

Xeroderma pigmentosum fibroblasts (XPF) are defective in therepair of certain DNA adducts. We show here that XPF cells aremore sensitive to the toxic effects of chrysotile, amosite andcrocidolite asbestos than are normal human fibroblasts (NF).XPF cells from different complementation groups have a sensitivityto chrysotile which parallels the degree of their DNA repairdeficiency. In addition, the survival of normal cells afterchrysotile exposure increases with time if they are kept fromreplicating, while the survival of XPF cells under the samecircumstances does not change.