The Sydney System: Epidemiology and natural history of chronic gastritis

Chronic gastritis is a common disease which forms an important background to the pathogenesis of several gastric diseases. In most instances, gastritis seems to be a bacterial (microbial) disease. It begins as long-lasting, chronic inflammatory reaction directed against Helicobacter pylori (HP), or occasionally against other spiral bacteria, which colonize in the space between the surface epithelium and the mucous layer. Gastritis may, irrespectively of the HP-related or HP-independent origin, progress to an atrophy (chronic gastritis with atrophy) in the underlying mucosa. Prevalence of gastritis increases with increase in age, but great variations exist in the age-specific prevalence and in mean age of onset of the gastritis in different populations. A high rate and an early onset of the HP-related gastritis associates with low socio-economic status. Chronic gastritis, and the gastritis with atrophy in particular, may interfere with the function of the affected gastric mucosa, and may subsequently increase or decrease the risk of some gastric diseases, such as cancer and peptic ulcer. Both antral and corpus gastritis with coexistent severe atrophic changes have been shown to be associated with an increased risk of gastric cancer. In addition, gastritis seems to also play an important role in the pathogenesis of peptic ulcer. Virtually all patients with DU and GU have coexisting and preceding gastritis. The cumulative risk of ulcer has been estimated to be high in subjects with gastritis, but, in contrast, to be low in subjects who have normal gastric mucosa.     

Detection of periodic leg movements with a static-charge-sensitive bed

SUMMARY We evaluated the performance of the static-charge-sensitive bed (SCSB), a non- invasive movement sensor, in detecting nocturnal periodic movement activity using simultaneous bilateral anterior tibialis electromyography (EMG,) as a reference. Two different study setups were used, one with 500 random record extracts, another with 10 continuous recordings. The inter-rater reliability between two independent scorers was 0.92 in scoring EMG, and 0.91 in scoring SCSB. In an epoch based analysis, depending on the study setup and scorer, the sensitivity of the SCSB to detect periodic leg movements was 0.81-0.94 whereas the specificity was 0.84-0.89. In a movement-by-movement analysis, despite incomplete concordance between the two methods the total number of movements per hour were comparable. Our findings support the use of the SCSB as a non-invasive alternative to anterior tibialis EMG recordings to reveal the presence of nocturnal periodic movement activity and estimate its frequency.     

Modern Methods for Reliable Preoperative Localization of Insulinoma

A case of insulinoma is reported in which the correct localization of tumor was made with PTP and immunoreactive insulin values from the portal venous system and in which pancreas angiography indicated a false positive tumor localization. PTP should be done to every patient to confirm the preoperative location of the insulinoma(s).     

THE EFFECT OF ALCOHOL ON MALE AND FEMALE SEXUAL FUNCTION

In the chronic male alcoholics several mechanisms are involvedin the pathogenesis of the sexual dysfunction that manifestsitself clinically as testicular atrophy, gynaecomastia, impotenceand sterility. Animal studies have distinctly demonstrated theability of alcohol to impair testosterone production and spermatogenesisboth through its direct toxic effects on the testes and throughinterference in the function of the hypothalamic-pituitary-gonadalaxis. The alcohol-induced enhancement of testosterone catabolismalso contributes to the loss of plasma testosterone. Apart frombeing hypoandrogenized, chronic alcoholic men are also exposedto the excessive oestrogen effect that results from the accumulationof oestrogenic hormones, principally from that of oestrone,and from the changes in oestrogen receptors. The role of hyperprolactinaemiain the alterations of sexual function of chronic male alcoholicsis unknown. The significance of liver damage in the pathogenesisof hormonal disturbances is emphasized by the finding that,apart from impairment of spermatogenesis, the hormonal changesseem to be most marked in alcoholic men with liver cirrhosis. Animal studies have again dearly demonstrated the toxicity ofalcohol to female gonads. Consistent with the animal findings,menstrual abnormalities, decreased female sexual characteristicsand sterility associated with ovarian atrophy have been reportedin chronic alcoholic women. The loss of oestrogens and progesteroneprovides the hormonal basis for these changes. In spite of markedhypo-oestrogenization, plasma gonadotropin levels have not beenelevated in chronic female alcoholics, indicating that disturbedregulation of gonadotropin secretion is an important factorin the genesis of ovarian failure in these patients, even ifovarian function may also be directly impaired. Hyperprolactinaemiais not one of the hormonal hallmarks of sexual dysfunction inchronic alcoholic women.     

Indomethacin and Canine Lower Esophageal Sphincter Pressure

A total of 20 experiments were carried out on 10 dogs to investigate the effect of indomethacin, administered rectally, on the canine lower esophageal sphincter pressure (LESP). Indomethacin increases LESP. Its effect begins 60 minutes after rectal administration and lasts for about 120 minutes. It readies its highest level 90 minutes after administration. Indomethacin has no effect on the canine fundal or esophageal pressure.     

Persistence of borrelial DNA in the joints of Borrelia burgdorferi‐infected mice after ceftriaxone treatment

Yrjänäinen H, Hytönen J, Hartiala P, Oksi J, Viljanen MK. Persistence of borrelial DNA in the joints of Borrelia burgdorferi‐infected mice after ceftriaxone treatment. APMIS 2010; 118: 665–73. We have earlier shown that Borrelia burgdorferi‐infected and ceftriaxone‐treated mice have viable spirochetes in their body, since immunosuppressive treatment allows B. burgdorferi to be detected by culture. However, the niche of the persisting spirochetes remained unknown. In the present study, we analyzed the tissues of B. burgdorferi‐infected and ceftriaxone‐treated mice by culture and PCR to reveal the foci of persisting spirochetes. C3H/HeN mice were infected via intradermal needle injection with B. burgdorferi s.s. N40. The mice were treated as follows: (i) short (5 days) and (ii) long (18 days) course of ceftriaxone at 2 weeks of infection and killed after either 10 or 30 weeks, or (iii) the mice received ceftriaxone for 5 days at 18 weeks of infection and were killed 21 weeks after the treatment. All samples of ceftriaxone‐treated mice were culture negative, whereas all untreated controls were culture positive. Importantly, B. burgdorferi DNA was detected in the joints of 30–100% of the treated mice. In conclusion, these results combined with earlier results suggest that the joint or a tissue adjacent to the joint is the niche of persisting B. burgdorferi in ceftriaxone‐treated mice.     

Mexiletine for the Management of Ventricular Arrhythmias in Ischemic Heart Disease

Mexiletine, a type IB anti arrhythmic agent, has recently been released in the United States for use in the oral treatment of ventricular arrhythmias. It is as effective as other group IB and LA drugs, and less effective than group 1C agents such as propafawne, flecainide, and amiodarone; however, it has the advantage of being associated with fewer serious adverse effects. Mexiletine will control ventricular tachycardia in patients with drug-resistant arrhythmias in 20–30% of cases; in unselected populations it may abolish VT in 50–96%. It is recommended that mexiletine be combined with beta blockers and/or group IA drugs for treating resistant arrhythmias. Efficacy may be increased and adverse side effects reduced through use of smaller dosages and combination therapy.     

Skin lesions in human yersiniosis

Various types of skin manifestations of human yersiniosis were examined with routine histological and immunohistological methods. The biopsy material consisted of sixteen cases of erythema nodosum, eight cases of erythema multiforme, and one case of erythema figuratum. The principal histopathological changes in erythema nodosum were septal or diffuse, mild panniculitis and in seven cases also necrotizing vasculitis in small, medium-sized or large arteries. Perivascular lymphocytic infiltration without vasculitis was the most prominent feature in erythema figuratum. By using a polyvalent conjugate, immunoglobulins in vessel walls in the dermis were found in two cases of EM. The rapid course of the skin eruptions and the frequency of necrotizing vasculitis in arteries fit the changes seen in an experimental Arthus reaction, in which necrotizing vasculitis is followed by lymphocytic inflammation consistent with a delayed type of reaction.