Helicobacter pylori clearance and serum gastrin and pepsinogen I concentrations in omeprazole treatment of duodenal ulcer patients

Objective: To determine which demographic factors may influence serum gastrin and pepsinogen I (PGI) levels in duodenal ulcer patients undergoing omeprazole treatment. Methods: We conducted an outpatient-based prospective study in the Veterans General Hospital, Taipei, to investigate the pharmacological effects on patients with duodenal ulcers receiving omeprazole treatment for 4 weeks. Sixty-eight patients (61 males/7 females, aged 25–73 years) with endoscopically confirmed duodenal ulcer were included. Gastrin and pepsinogen I levels were measured before and after treatment. Demographic factors including age, sex, smoking, ulcer healing and antral Helicobacter pylori colonization/clearance were analyzed, in order to measure their probable influences on serum gastrin and pepsinogen I levels. Results: Ulcer healing was seen in 92.6% of patients while 48 (70.6%) antral clearances were seen in 66 H. pylori colonized patients at the end of trial. Omeprazole monotherapy led to a marked elevation of serum gastrin (85.8 pg · ml⁻¹, SD 32.0 pg · ml⁻¹ vs 133.9 pg · ml⁻¹, SD 71.6 pg · ml⁻¹, P < 0.01), and pepsinogen I (111.0 ng · ml⁻¹, SD 36.7 ng · ml⁻¹ vs 253.6 ng · ml⁻¹, SD 64.8 ng · ml⁻¹, P < 0.01) levels when measured on day 29. Only patients showing antral H. pylori clearance exhibited an influence on the magnitude of pepsinogen I elevation following omeprazole monotherapy (143.9%, SD 67.3% vs 78.6%, SD 51.2%, P < 0.01). Moreover, the sensitivity and specificity of serum pepsinogen I variations were plotted on a receiving operating characteristic (ROC) curve. The 140% increased pepsinogen I level yielded a maximum accuracy of 80% specificity or 50% sensitivity to predict antral H. pylori clearance. Conclusion: Antral H. pylori clearance is at least partially responsible for the omeprzaole-induced hyperpepsinogenemia I. The magnitude of hyperpepsinogenemia I probably provides a non-invasive alternative for predicting H. pylori clearance. Received: 22 August 1996 / Accepted in revised form: 1 October 1998     

Ergebnisse der selektiv proximalen vagotomie nach 13 Jahren

Zusammenfassung Es wird über die Langzeitergebnisse von 216 Patienten berichtet, bei denen zwischen 1970 und 1978 wegen eines Ulcus duodeni eine selektiv proximale Vagotomie (SPV) vorgenommen wurde. Die mittlere Nachbeobachtungszeit beträgt 12,8 Jahre (8,3–15). 26 Patienten erlitten ein symptomatisches Ulkusrezidiv (12%)4–135 Monate postoperativ, die kumulative Rezidivrate beträgt 20,3 % nach 13 Jahren (Kaplan-Meier). Säuresekretionsmessungen ergaben eine mittlere Reduktion der basalen (BAO) und mittleren stimulierten Sekretionswerte (MAO) von 80,7 bzw. 74,8 % ohne Unterschiede zwischen Patienten mit und ohne Rezidiv. Das Rezidivrisiko war für Ulcus duodeni (22 von 194) und pylorische Geschwüre (4 von 22) vergleichbar, ebenso fanden sich keine Unterschiede bezüglich dem Geschlecht, einer zusätzlichen Drainage-Operation, dem Rauchverhalten, akuter oder elektiver Operation und erstem oder Rezidivgeschwür. Nach der Operation komplizierter Ulzera war das Rezidivrisiko tendentiell höher (p 0,07). 78,5% der Patienten erreichten ein (sehr) gutes funktionelles Langzeitergebnis (Visick I oder II), nur 6% mußten als Visick III eingestuft werden. Die SPV kann daher als ein ungeachtet der Patienten-Compliance wirksames und wertvolles Therapieverfahren zur Behandlung des Ulcus duodeni erachtet werden.

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Results of highly selective vagotomy after 13 years

Summary This study reports the long-term results of 216 patients after highly selective vagotomy (HSV) for duodenal ulcers operated from 1970 through 1978 with a mean follow-up of 12.8 years (8.3–15). 26 patients developed symptomatic ulcer recurrences (12%) within 4 to 135 months following surgery, the cumulative recurrence rate (Kaplan-Meier) at 13 years was 20.3%. Acidity analyses showed a postoperative mean reduction of basal acid output (BAO) and maximal acid output (MAO) values of 80.7 % and 74.8 % respectively with no differences according to recurrences. The risk of recurrence was similar for duodenal (22/194) and pyloric ulcers (4/22) and no differences were found with respect to sex, additional drainage procedure, smoking habits, acute or elective operation and first or recurrent ulcers. Risk was slightly higher for complicated ulcers (p 0.07), but without reaching statistical significance. 78.5% of patients showed (very) good results (Visick I or II), only 6% were Visick III. HSV is therefore regarded as a valuable therapeutic measure for the treatment of duodenal ulcer independent of patient compliance.

     

Effect of aging on bladder function and the response to outlet obstruction in female rats

Bladder dysfunction in the aging population is a significant problem. However the concomitant presence of other diseases in many patients can make it difficult to distinguish between changes in bladder function and other influences. The present study was designed to study, in aging rats, bladder function and the effect of partial bladder outlet obstruction (BOO) on bladder function. Cystometrics were performed in awake, female Fischer 344 rats of four age groups (6, 12, 18 and 24 months) following subcutaneous implantation of a mediport catheter. Cystometric evaluations were carried out in control rats or those subject to three weeks of BOO. Bladder compliance significantly decreased with aging, which reflected an increase in threshold pressure without changes in bladder capacity. Partial BOO caused development of severe bladder instability. Following BOO, bladder capacity and compliance were significantly increased in all age groups. Threshold pressure was lower in obstructed animals, except for 6-month rats. Younger animals were able to generate a higher contraction pressure to compensate for the BOO, whereas older animals did not. Using an awake model of cystometric measurement, we have demonstrated that aging, by itself can affect bladder function. Furthermore, aged animals respond differently to BOO than younger animals. These results demonstrate that both aging and disease can contribute to bladder dysfunction, and suggest that treatment of bladder dysfunction may require a combination of therapies targeted to multiple etiologies. Received: 18 August 1998 / Accepted: 6 July 1999     

子痫前期与子痫终止妊娠时机及方式的探讨

目的探讨子痫前期与子痫终止妊娠的时机和方式对母婴的影响。方法对42例患者进行了回顾性分析，观察新生儿的窒息率和死亡率。结果产前子痫5例，产时子痫4例，产后子痫2例，子痫前期30例，母亲全部存活，剖官产率86．70％，新生儿窒息率92．85％，围生儿死亡率5．8％。结论治疗子痫前期与子痫适时终止妊娠是极重要的方法，终止妊娠的方式首选剖宫产。     

Does gut atresia cause polyhydramnios?

Fetal gut atresia is variably associated with polyhydramnios. In order to determine which pregnancies will develop polyhydramnios, the case notes of 80 babies with gut atresia and stenosis were reviewed. Maternal polyhydramnios developed in all cases of pure oesophageal atresia (n=8), all cases of Type III duodenal atresia (DA) with a non-bifid bile duct (n=8), 80% of cases with type I DA (n=10), and 24% of atresias of the small intestine (n=34). Polyhydramnios did not develop in any case where there was not total obstruction except in 1 baby with DA and a bifid bile duct (BBD). These included stenosis of the oesophagus and duodenum (n=17) and DA type III with a BBD (n=3). These results support the role of fetal swallowing and fluid absorption by the fetal gastro-intestinal tract in the regulation of amniotic fluid volume. Accepted: 24 February 1997     

胃癌患者血清和组织一氧化氮水平变化及临床意义

应用比色法测定了３４例胃癌患者血清和组织粘膜的一氧化氮（ＮＯ）含量，并设３０例正常人及３０例球部溃疡为血清对照组。２３例组织对照组系取自癌旁组织（肉眼和病理均属正常）。结果显示胃癌患者血清一氧化氮水平明显低于正常对照组及十二指肠球溃疡组（Ｐ＜０．０１）；而十二指肠球溃疡组则明显高于正常对组（Ｐ＜０．０１），胃癌组织中ＮＯ含量则显著高于癌旁组织（Ｐ＜０．０１）。研究表明当肿瘤发生时，经诱导活化的巨噬细胞可以产生大量的ＮＯ於病灶组织中而发挥其免疫功能，即ＮＯ直接作用于肿瘤细胞，启动机体其他免疫防御系统而杀伤肿瘤细胞并在粘膜损伤时有重要的修复功能。故而表现出血中ＮＯ水平下降，而胃癌组织局部ＮＯ水平升高。     

高频电灼加留置硅胶管治疗泪小管阻塞

目的 探讨高频电灼联合硅胶管植入术治疗泪小(总)管阻寨的适应证,手术方法和临床疗效.方法 对2年来行高频电灼联合硅胶管植入术治疗的泪道阻塞62例(68只眼),进行回顾性分析.结果 62例(68只眼)泪小(总)管阻塞有效率达88.2%.结论 高频电灼联合硅胶管植入术治疗泪小(总)管阻塞具有成功率高,操作简便,并发症少,经济,损伤小和美观等优点,具有临床适用价值.     

幽门螺杆菌阳性十二指肠球部溃疡患者红细胞免疫功能的变化

目的:探讨幽门螺杆菌(Hp)阳性十二指肠球部溃疡患者红细胞免疫功能的变化。方法:47例Hp阳性十二指肠球部溃疡和32例健康体检者入选,前者以标准方案治疗7d,后者不予处理作为对照。治疗前后分别以流式细胞仪测定其血液红细胞上CR1的数量,以免疫粘附酵母菌花环法测定其活性。结果:与正常人相比,Hp阳性十二指球部溃疡红细胞C3b受体花环率、红细胞CR1数量降低(P<0.01),红细胞免疫复合物花环率增高(P<0.01)。结论:Hp的感染可能是导致十二指肠球部溃疡患者红细胞免疫功能低下的原因。     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.