“Cervia II Working Group Report 2006”: Guidelines on diagnosis and treatment of Helicobacter pylori infection in Italy

Proper management of Helicobacter pylori infection in clinical practice--when supported by evidence-based data--is expected to produce substantial cost-efficacy advantages. This consideration has prompted the Cervia Working Group to organise a meeting of experts to update the National Guidelines on the diagnosis and treatment of H. pylori infection in Italy. Recommendations in the new European Guidelines were considered in the National setting, here in the light of factors such as the incidence of gastric cancer and gastric lymphoma, the accessibility to different diagnostic tools, the prevalence of bacterial resistance against antibiotics, and the availability of different drugs. The main revisions in respect to the previous guidelines include H. pylori eradication in non-ulcer dyspepsia patients and in non-steroidal, anti-inflammatory drug users, as well as in patients with idiopathic thrombocytopenic purpura and iron deficiency anaemia. The stool antigen test is now accepted as a valid test for confirmation of H. pylori eradication following therapy. New therapeutic approaches have been recommended for both first- (sequential therapy) and second-line (levofloxacin-based) treatment in our country.     

Protection Against Chemically-Induced Oxidative Gastrointestinal Tissue Injury in Rats by Bismuth Salts

Oxygen free radicals (OFR) are implicated in thepathogenesis of stress, chemically induced gastriclesions, and gastrointestinal injury. Theconcentration-dependent scavenging abilities of bismuthsubsalicylate (SBS), colloidal bismuth subcitrate (CBS), andselected OFR scavengers, including superoxide dismutase(SOD), catalase, mannitol, and allopurinol were examinedagainst biochemically or chemically generated superoxide anion, hydroxyl radical, andhypochlorite radical plus hypochlorous acid based on achemiluminescence assay. Furthermore, both gastric (GM)and intestinal mucosa (IM) were individually exposed in vitro to these free radical generatingsystems, and the concentration-dependent protectiveabilities of SBS and CBS against lipid peroxidation (LP)were compared with selected OFR scavengers. In addition, 24-hr fasted rats were orally treated with thenecrotizing agents 0.6 M HCl, 0.2 M NaOH, 80% ethanol,and aspirin (200 mg/kg). The extent of tissue injury inthe GM and IM was determined by assessing LP, DNA fragmentation, and membrane microviscosity.Dose- and time-dependent in vivo protective abilities ofCBS (100 mg/kg) and SBS (15 mg/kg) were also assessed.Following incubations with superoxide anion and hydroxyl radical generating systems in thepresence of 125 mg SBS/liter, approximately 47% and 61%inhibitions were observed in the chemiluminescenceresponse, respectively, while 48% and 46% inhibitions were observed with 125 mg CBS/liter. SBS andCBS exerted similar abilities towards hypochloriteradical plus hypochlorous acid. Approx. 3.1- and3.7-fold increases in LP were observed in the GM and IMof rats following oral administration of 0.6 MHCl. Pretreatment of the rats with SBS and CBS decreased0.6 M HCl-induced LP in the GM by approx. 39% and 27%,respectively, with similar decreases in LP in the IM. SBS exhibited better protectiveabilities towards 0.6 M HCl and 0.2 m NaOH-induced GMand IM injury as compared to CBS. SBS and CBS providedsimilar protection towards 80% ethanol-induced gastric injury, while CBS exerted a superior protectiveability towards aspirin-induced gastric injury. Theresults demonstrate that both SBS and CBS can scavengereactive oxygen species and prevent tissue damage produced by OFR.     

Patients with Alcohol Problems in the Emergency Department,Part 1: Improving Detection*

Abstract. Medical and social problems related to alcohol use are frequently seen in the ED. Often, the tempo of emergency medicine practice seems to preclude assessment beyond that required by the acute complaint. However, detection of ED patients with alcohol problems can occur using brief screening tools. This article was developed by members of the SAEM Substance Abuse Task Force, and describes screening tools that have been used successfully to identify atrisk and dependent drinkers. Their brevity, reproducibility, and accuracy vary somewhat, but screening can be realistically performed in the busy ED setting. The early detection of patients with alcohol problems would provide the opportunity for early intervention, and may reduce subsequent morbidity and mortality in this patient population.     

Teaching children about skin cancer prevention: why wait for adolescence?

Abstract: The baseline knowledge about skin cancer prevention of 983 children aged 8 to 12 years was assessed by a pretest questionnaire. After the pretest, half were given a formal presentation about skin cancer prevention. The other half participated in an informal, question–and–answer session, which covered all material from the formal presentation. Two weeks later, all students completed an identical post–test. The students had a high baseline level of knowledge about skin cancer prevention. Knowledge increased for most items in the post–test questionnaire. In all age groups there was no difference in results between the formal and interactive teaching sessions, except among eight–year–olds, for whom the formal presentation was more effective. As much solar skin damage occurs before adolescence, the younger age group is the important target for skin cancer prevention programs. (Aust N Z J Public Health 1997; 21: 602–5)     

Tripotassium dicitrato bismuthate (TDB) versus two different dosages of cimetidine in the treatment of resistant duodenal ulcers.

The use of tripotassium dicitrato bismuthate (TDB) has been suggested recently for cimetidine resistant duodenal ulcers. This study compares the efficacy of TDB with two different cimetidine dosages in the treatment of duodenal ulcer patients who failed to respond to an eight week therapy with H2-blockers. Fifty two patients (40 men, 12 women) were randomly allocated to one of the following three oral regimens: (1) TDB 120 mg quid, (2) cimetidine 400 mg tid, (3) cimetidine 400 mg with meals plus 800 mg at bedtime. Endoscopy was carried out after four weeks; if the ulcer had not healed patients continued with the same treatment for a further four week period when they were endoscopically reassessed. After four weeks similar percentages of ulcer healing were registered in the two cimetidine schedules (39% with 1.2 g and 44% with 2 g), whereas TDB resulted in a significantly higher healing rate (82%) compared with cimetidine 1.2 g (p = 0.01) and with cimetidine 2 g (p = 0.025). After eight weeks the cumulative percentages of healing were 65% on cimetidine 1.2 g, 75% on cimetidine 2 g, and 94% on TDB (TDB v cimetidine 1.2 p = 0.042). These results confirm previous data that resistant duodenal ulcers are more responsive to an agent which strengthens the mucosal defences than to antisecretory compounds.     

Differential protective effects of varying degrees of hypoxia on the cytotoxicities of etoposide and bleomycin

Summary Oxygen is thought to be involved both directly and indirectly in the mechanisms of action of several anticancer agents. We studied the effects of various oxygen concentrations on the cytotoxicities of the following drugs: bleomycin (BLM), etoposide (VP-16), doxorubicin (DOX), and mitomycin C (MMC). Human sarcoma cells, MESSA, were exposed to drug for 1 h at one of several oxygen concentrations: less than 1%, 2.5%, 5%, 21%, and 95%. Cytotoxicity was assessed by cellular incorporation of ³H-thymidine into DNA 5 days after drug exposure. Control experiments varying oxygen concentration without drugs demonstrated toxicity only at the highest concentration (95%). Three different responses of drug sensitivity to varying oxygen tensions were observed. BLM, which has been shown to utilize oxygen as a substrate in generating free radicals and producing DNA scission, demonstrated a progressive increase in cytotoxicity over the entire range of increasing oxygen concentrations. This is consistent with the model of a BLM-cation-oxygen complex and catalytic reduction of oxygen. VP-16, which also produces DNA strand breakage but by interaction with topoisomerase II, exhibited a threshold response. VP-16 toxicity was ameliorated by anoxic conditions (less than 1% O₂), but not by oxygen concentrations of 2.5%–95%. The reason for this protective effect of anoxia with VP-16 is not clear. In contrast, acute anoxia had no effect on the cytotoxicities of DOX and MMC. We conclude that acute hypoxia protects cells from both BLM and VP-16 but that the nature of that protection is different. VP-16 toxicitiy is blunted only by severe anoxia, wheaeas BLM exhibits a dose response effect over the entire range of oxygen concentrations.Supported by NIH grant CA-27478 from the US Department of Health and Human Services, and by the American Lung Association. Dr. Sikic is a recipient of a Faculty Development Award in Clinical Pharmacology from the Pharmaceutical Manufacturer's Association Foundation.     

Treatment of dural sinus thrombosis using selective catheterization and urokinase

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).