BEDSIDE ANGIOGRAPHY OF THE LUNG BY SWAN-GANZ CATHETER: A case report

A Swan—Ganz catheter, employed for haemodynamic monitoring,was put to a use not described previously. Pulmonary angiographywas performed through the catheter at the bedside with minimaldiscomfort or complication. In this case it was possible todetermine that a lung abscess was responsible for a translucencyin sthe right lower lobe. This was subsequently confirmed atpostmortem examination.     

Treatment of Helicobacter pylori infections

The available literature on the relationship between severaldiseases and Helicobacter pylori (H. pylori) is reviewed. Duodenalulcer, gastric ulcer, complicated peptic ulcer, abdominal symptomsand gastroduodenal mucosal damage during the use of non-steroidalanti-inflammatory drugs (NSAIDs), non-ulcer dyspepsia (NUD)and gastric malignancy are discussed. The case for and againsteradication is critically discussed. Eradication of H. pylorishould be pursued in all patients with peptic ulcer disease,whether they are using NSAIDs or not. Eradication of H. pyloriin the treatment of NUD should be considered experimental. Treatmentaimed at the eradication of H. pylori should be considered inall patients with low-grade malignant mucosaassociated lymphoidtissue (MALT) lymphoma and in all patients with Menetrier'sdisease. Finally, this treatment should be considered in a subsetof H. pylori-infected patients who possibly are at an increasedrisk of gastric cancer: patients with a strong family historyof gastric carcinoma and patients in need of long-term treatmentwith a proton-pump inhibitor. In view of the importance of patientcompliance, the risk of side-effects and the possibility ofinducing metronidazole resistance when treatment with a metronidazole-containingregimen is used, treatment aimed at the eradication of H. pylorishould be carefully implemented and monitored.     

Short report: clarithromycin, an alternative to metronidazole in the triple therapy of Helicobacter pylori infection

Background: Triple therapy for Helicobacter pylori using metronidazole is less effective in patients with a metronidazole resistant strain. Moreover, metronidazole is responsible for many side-effects. This open study examined the efficacy and side-effects of a triple treatment regimen substituting clarithromycin for metronidazole. Methods: 36 patients with a H. pylori infection, proven by culture, were treated with tripotassium dicitrato bismuthate 120 mg q.d.s., tetracycline 250 mg q.d.s. and clarithromycin 250 mg q.d.s. for 10 days. Eradication was defined as a negative culture and histological examination of antral biopsy specimens, taken at least 6 weeks after completion of the treatment. Results: Eradication was achieved in 26 patients (72%). The treatment was well tolerated with only 4 (11 %) of the patients having significant side-effects. Conclusion: Triple therapy with clarithromycin seems to be less effective than standard triple treatment when the prevalence of metronidazole resistance is low. It is suggested, however, that this combination could be a valuable alternative in areas with a high prevalence of metronidazole resistance.     

One-week triple therapy with omeprazole, amoxycillin and tinidazole for Helicobacter pylori infection: the significance of imidazole resistance

Background : Triple therapy involving a proton pump inhibitor and two antibiotics has been suggested as an effective treatment for Helicobacter pylori infection. The impact of imidazole resistance on the efficacy of such regimens is largely unknown.
Methods : One hundred patients with culture proven H. pylori infection were treated with omeprazole 40 mg b.d., amoxycillin 1000 mg b.d., and tinidazole 500 mg b.d. for one week. Pre-treatment imidazole susceptibility was measured by disk diffusion. Resistance was confirmed by E -test. Eradication was assessed by endoscopy 6–8 weeks after the end of treatment. In cases of doubt a ¹³C-urea breath test was performed. Side-effects were scored using a semiquantitative scale.
Results : H. pylori was eradicated in 95% of the patients with an imidazole-susceptible strain and in 69% of the patients with a resistant strain ( P <0.005). Significant side-effects were seen in 12%.
Conclusion : This proton pump inhibitor triple therapy is a simple, reasonably effective regimen with few significant side-effects. The efficacy is dependent on the susceptibility of the infecting H. pylori strain.