Long-term effect of Helicobacter pylori eradication on quality of life,body mass index,and newly developed diseases in Japanese patients with peptic ulcer disease

BACKGROUND/AIMS: Eradication of Helicobacter pylori is known to reduce ulcer recurrence in patients with peptic ulcer disease, however, other long-term effects after eradication therapy are not well known. The aim of this study is to examine the long-term effect of H. pylori eradication on clinical symptoms, quality of life, body mass index, newly emerging symptoms, and newly developed diseases. METHODOLOGY: One hundred and ninety-two Japanese patients with peptic ulcer disease who received H. pylori eradication therapy at Department of Gastroenterology, Osaka City University Hospital between 1993 and 1995 were asked to fill in specially a prepared questionnaire. RESULTS: One hundred and fourteen patients returned the questionnaires; out of them 98 could be analyzed in this study. Successful eradication (n = 88) resulted in alleviation of symptoms, improvement of quality of life and increase of body mass index while failure of eradication (n = 10) had much less or no effects. A relatively high incidence of hyperlipidemia (25.0%) was observed in patients with successful H. pylori eradication. Development of hyperlipidemia was associated with significant improvement of quality of life especially the item concerning eating and drinking habits but not with increased body mass index. In the elderly, no significant change in body mass index was observed, however, post-eradication body mass index was significantly higher in patients with hyperlipidemia than those without. CONCLUSIONS: Cure of H. pylori infection alleviates symptoms and improves quality of life of treated patients, but might be associated with an increased incidence of hyperlipidemia.     

Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals

OBJECTIVE:

To determine the prevalence of vancomycin-resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing.

DESIGN:

Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin-nalidixic acid-vancomycin (6 μg/mL) (CNAV) agar plates. The study was divided into six, eight-week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE.

MAIN RESULTS:

A total of 1408 stool specimens were submitted over the 48-week study period. Sixty-seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin-resistant E faecium -VREF- (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and {"type":"entrez-nucleotide","attrs":{"text":"LY333328","term_id":"1257359838"}}LY333328.

CONCLUSION:

VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).Key Words: Manitoba, Prevalence, Vancomycin-resistant enterococciVancomycin-resistant Enterococcus faecium (VREF) accounts for up to 65% of E faecium isolates in hospitalized patients across the United States and is endemic in many North American tertiary care institutions (1,2). The management of these infections presents a significant clinical challenge because species of the genus Enterococcus, and in particular E faecium, are frequently resistant to several antimicrobial agents (3). High level penicillin resistance, high level aminoglycoside resistance and most recently vancomycin resistance are emerging as significant concerns in the treatment of enterococcal infections. This has prompted the development and evaluation of new antimicrobial agents such as quinupristin/dalfopristin and {"type":"entrez-nucleotide","attrs":{"text":"LY333328","term_id":"1257359838"}}LY333328, a glycopeptide, which may offer activity against enterococci resistant to conventional therapy (2).VREF is not endemic in Manitoba hospitals, and infection with VREF is extremely rare (4). However, the prevalence of VREF lower gastrointestinal tract (GIT) carriage, which frequently precedes infection (5,6), is presently unknown for patients hospitalized in Manitoba. To determine whether the lack of VREF endemnicity correlated with an absence of lower GIT colonization, we assessed lower GIT carriage of VREF for patients hospitalized in 10 Manitoba hospitals from January 1 to December 31, 1997. Our study was consistent with Centers for Disease Control and Prevention guidelines (Atlanta, Georgia) that suggest surveillance programs for vancomycin-resistant enterococci (VRE) be undertaken on an intermittent basis in areas where VRE is not known to be endemic (6). Isolates of VREF identified were phenotypically and genotypically characterized, and tested for their susceptibilities against a panel of antimicrobial agents.     

A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity and reproducibility

Wave intensity (WI) is a new hemodynamic index that provides information about the dynamic behavior of the heart and the vascular system and their interaction. Carotid arterial wave intensity in normal subjects has two positive peaks. The first peak, W₁, occurs during early systole, the magnitude of which increases with increases in cardiac contractility. The second peak, W₂, which occurs towards the end of ejection, is related to the ability of the left ventricle to actively stop aortic blood flow. Between the two positive peaks, a negative area, NA, is often observed, which signifies reflections from the cerebral circulation. The time interval between the R-wave of ECG and the first peak (R − W₁) corresponds to the pre-ejection period, and that between the first and second peaks (W₁ − W₂) corresponds to ejection time. We developed a new ultrasonic on-line system for obtaining WI and arterial stiffness (β). The purpose of this study was (1) to report normal values of various indices derived from WI and β measured with this system, and (2) to evaluate the intraobserver and interobserver reproducibility of the measurements. The measurement system is composed of a computer, a WI unit, and an ultrasonic machine. The WI unit gives the instantaneous change in diameter of the artery and the instantaneous mean blood velocity through the sampling gate. Using these parameters and blood pressure measured with a cuff-type manometer, the computer gives WI and β. We applied this method to the carotid artery in 135 normal subjects. The mean values of W₁, W₂, NA, R − W₁, and W₁ − W₂ were 8 940 ± 3 790 mmHg m/s³, 1 840 ± 880 mmHg m/s³, 27 ± 13 mmHg m/s², 104 ± 14 ms, and 270 ± 19 ms, respectively. These values did not show a significant correlation with age. The mean value of β was 10.4 ± 4.8 and the values significantly correlated with age (men: r = 0.66, P < 0.0001; women: r = 0.81, P < 0.0001). The reproducibility was evaluated by intraobserver intrasession (IA), intraobserver intersession (IE), and interobserver intrasession variability (IO). The reproducibility of R − W₁ and W₁ − W₂ was high: the mean coefficient of variation (mCV) of IA was less than 3%; 95% confidence limits from the mean values (CL) were less than 8% for IE and less than 4% for IO. The reproducibility of W₁ and β was good: mCV for IA was less than 10%; CL for IE and IO were less than 17%. W₂ and NA showed a higher variability than other indices: mCV for IA was less than 13%, and CL for IE and IO were less than 36%. However, two sessions by the same observer and two sessions by different observers were not biased. Wave intensity measurements with this system are clinically acceptable. Received: March 25, 2002 / Accepted: June 17, 2002 Acknowledgments K.N. and M.S. were supported by Grants-in-Aid for Scientific Research (B)-11695092 and (C)-11670713 from the Ministry of Education, Science, Sports and Culture of Japan. Correspondence to K. Niki     

Compression and expansion wavefront travel in canine ascending aortic flow: wave intensity analysis

The forces underlying left ventricular ejection were investigated by applying a wavefront analysis to blood pressure (P) and velocity (U) waveforms measured in the ascending aorta of anesthetized dogs (n = 13). Wavefronts travel forward (to the periphery) and/or backward (to the heart) after peripheral reflection. They are characterized by the rate of pressure change they cause, i.e., the time derivative of pressure (dP/dt): compression wavefronts have dP/dt > 0; expansion wavefronts have dP/dt < 0. Wave intensity is defined as (dP/dt)(dU/dt), where dU/dt is the time derivative of U. Forward wavefronts contribute positively to wave intensity and backward wavefronts contribute negatively. Therefore, wave intensity indicates whether the effects of forward wavefronts are predominant or whether those of backward wavefronts predominate in the formation of pressure and velocity waveforms. Under control conditions, wave intensity was positive in early and late systole, indicating that forward compression and expansion wavefronts dominate aortic acceleration and deceleration, respectively. Compression wave intensity was increased during inotropic stimulation by dobutamine (10–15 μg/kg per min i.v. infusion; +161% ± 31% mean change in peak value ± SEM (%), P < 0.05), and was reduced during β-blockade by propranolol (1 mg/kg i.v. injection; −58% ± 7%, P < 0.05). Expansion wave intensity was unchanged by dobutamine and propranolol (n = 6). In a separate group of animals (n = 7), expansion wave intensity was reduced during vasodilatation by nitroglycerin (0.5 mg i.v. injection and 0.02 μg/kg per min infusion; −32% ± 12%, P < 0.05), but was unchanged during vasoconstriction by methoxamine (2 mg i.v. injection). However, methoxamine reduced compression wave intensity (−46% ± 14%, P < 0.05). These results indicate that (1) compression and expansion wavefronts generated by the left ventricle dominate acceleration and deceleration in the ascending aorta, (2) compression wave intensity is related to the inotropic state of the left ventricle, but is reduced during vasoconstriction, and (3) expansion wave intensity is reduced during vasodilatation. This time domain analysis of traveling wavefronts readily provides information concerning the dynamics of the ventriculoarterial interaction. Received: January 27, 2001 / Accepted: October 19, 2001     

Direct dissolution of gallstones with methyl tert-butyl ether (MTBE) via endoscopic transpapillary catheterization in the gallbladder (ETCG)

In a pilot study of direct dissolution therapy of gallstones with methyl tert-butyl ether (MTBE), endoscopic transpapillary catheterization in the gallbladder (ETCG) was performed. Complete dissolution was seen in 8 out of 12 (66%) patients and partial dissolution was seen in 2 (16%) patients. In one of the 8 complete dissolution patients, combined extracorporeal shock wave lithotripsy (ESWL) and dissolution therapy was carried out successfully. These 8 patients were followed up for 12–20 months with regular ultrasonography. During this period, 1 patient underwent laparoscopic cholecystectomy due to stone recurrence. Thickening of the gallbladder wall was seen in 2 patients, but there were no other complications. Using Tsuchiya's classification based on ultrasound, complete dissolution was seen in type Ia stones. This pilot study suggests that the direct dissolution of gallstones with MTBE via ETCG might be a useful and safe non-invasive treatment in patients with cholesterol stones in preserved gallbladders.     

Marrow harvesting from normal donors

The experience at a single institution in harvesting marrow for allogeneic transplantation on 1,270 occasions from 1,160 normal donors is presented in detail, together with an analysis of all the donor complications. Four donors were less than 2 years old, and the youngest was 6 1/2 months. No special difficulties were encountered with these young donors. Hospitalization time was three days or less for 99% of the procedures. Six donors had life-threatening complications; three of a cardiopulmonary and two of an infectious nature, and one cerebrovascular embolic episode. Significant operative site morbidity, usually transient neuropathies, occurred in ten procedures. Ten percent of the donations were associated with transient postoperative fever of unknown origin. Increasing donor age was associated with a reduction of the cellularity of the marrow harvest. The use of stored autologous blood permitted the avoidance of blood bank transfusion in 81% of males, 69% of females, and 50% of children. It was concluded that the procedure was associated with a very low risk of complication, but that the involvement of normal donors in such an operation justifies stringent monitoring.