Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment

Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.     

Radiation Processed Amniotic Membranes in the Treatment of Non-Healing Ulcers of Different Etiologies

The amniotic membranes were collected from the placentae of selected and screened donors. Processing was done by washing the fresh amniotic membrane successively in sterile saline, 0.05% sodium hypochlorite solution and sterile distilled water until it was completely cleared of blood particles. The membranes were sterilized by gamma irradiation at 25 kGy. The processed amniotic membranes were applied to 50 open wounds comprising of 42 full thickness defects and eight partial thickness defects. These included leprotic, diabetic, traumatic, gravitational ulcers and superficial burn in the form of scald and corrosive burn. The radiation processed amniotic membranes favoured healing of unresponsive and non-healing ulcers of different etiologies. Ulcers with duration of minimum 3 weeks to maximum 12 months were found to heal in 2-6 weeks by the application of amniotic membranes.     

Acute and sub acute toxicity study on Sangu parpam

Peptic ulcer is described in the siddha system of medicinal classification of 4448 diseases. Information on the use of Sangu Parpam in treating peptic ulcer is known. Therefore, it is of interest to document the acute and sub acute toxicity analysis on Sangu parpam in this regard.     

The N-terminal tridecapeptide fragment of gastrin-17 inhibits gastric acid secretion

After a meal the serum concentrations of the N-terminal tridecapeptide-like fragment of gastrin-17, (1-13)G-17, increased markedly in patients with active duodenal ulcer, but less so in healthy subjects. Consequently the synthetic (1-13)G-17 was infused intravenously in doses that resulted in concentrations similar to those measured in duodenal ulcer patients in order to examine whether the N-terminal fragment influences gastric acid secretion. Doses of 125 and 400 pmol (1-13)G-17/kg per h inhibited the meal-stimulated acid secretion by 36% (P less than 0.05) and 66% (P less than 0.05) respectively. The release of endogenous C-terminal gastrin immunoreactivity was not influenced. The infusion of (1-13)G-17 also inhibited the acid response to exogenous gastrin-34, gastrin-17 and Peptavlon, but not to gastrin-4. The results suggest that the N-terminal gastrin-17 fragment--although devoid of the hitherto considered only active site of gastrin--plays a significant role in the regulation of the gastric acid secretion in patients with active duodenal ulcer.     

Normalization of phospholipids concentration of the gastric mucosa was observed in patients with peptic ulcer after eradication of Helicobacter pylori

Background. Phospholipids concentration in the gastric mucosa decreased in patients with Helicobacter pylori infection. The aim of this study is to examine the effects of eradication of H. pylori on decreasing the phospholipids concentration in the gastric mucosa in patients with gastric or duodenal ulcer. Materials and Methods. Phospholipids (phosphatidylcholine, phosphatidylethanolamine, and sphingonomyeline) were measured in biopsy specimens from the antrum and corpus using thin‐layer chromatography. In H. pylori positive patients with gastric ulcer (n = 26) and duodenal ulcer (n = 13), and H. pylori negative controls (n = 20), the biopsy specimens were obtained before and 3 months after eradication. Eradication was performed using lansoprazole, amoxycillin, and clarithromycin. Results. Compared with the H. pylori negative control group, the concentrations of phosphatidylcholine and phosphatidylethanolamine decreased significantly in the gastric ulcer group in both antrum and corpus mucosa, and in the duodenal ulcer group in antrum mucosa. This decrease returned to the control level after eradication. Conclusions. This study demonstrates that the eradication of H. pylori in patients with peptic ulcer normalized the decrease of phosphatidylcholine and phosphatidylethanolamine in the gastric mucosa.     

Prevalence of duodenal ulcer-promoting gene (dupA) of Helicobacter pylori in patients with duodenal ulcer in North Indian population

BACKGROUND: The duodenal ulcer (DU)-promoting gene (dupA) of Helicobacter pylori has been identified as a novel virulent marker associated with an increased risk for DU. The presence or absence of dupA gene of H. pylori present in patients with DU and functional dyspepsia in North Indian population was studied by polymerase chain reaction (PCR) and hybridization analysis. MATERIALS AND METHODS: One hundred and sixty-six patients (96 DU and 70 functional dyspepsia) were included in this study. In addition, sequence diversity of dupA gene of H. pylori found in these patients was analyzed by sequencing the PCR products jhp0917 and jhp0918 on both strands with appropriate primers. RESULTS: PCR and hybridization analyses indicated that dupA gene was present in 37.5% (36/96) of H. pylori strains isolated from DU patients and 22.86% (16/70) of functional dyspepsia patients (p < or = .05). Of these, 35 patients with DU (97.2%) and 14 patients with functional dyspepsia (81.25%) were infected by H. pylori positive for cagA genotype. Furthermore, the presence of dupA was significantly associated with the cagA-positive genotype (p < or = .02). CONCLUSION: Results of our study have shown that significant association of dupA gene with DU in this population. The dupA gene can be considered as a novel virulent marker for DU in this population.     

脉冲染料激光治疗婴幼儿体表溃烂型血管瘤疗效研究

目的:观察波长为585 nm脉冲染料激光治疗婴幼儿体表溃烂型血管瘤的临床疗效。方法:采用波长为585 nm的脉冲染料激光,对76例(男26例,女50例)体表溃烂型血管瘤(平均瘤体表面积22.1 cm2)患者进行照射治疗,激光能量为5.8 J/cm2~8 J/cm2(平均6.6 J/cm2),间隔4周治疗一次,治疗二次后瘤体无消退者予口服类固醇辅助治疗,类固醇辅助治疗4周无效者再联合干扰素治疗,直至创面愈合和瘤体消失。结果:68例患儿在治疗二次后创面完全愈合,瘤体明显缩小,经一至八次(平均四次)激光治疗后瘤体完全消退,8例患儿辅以类固醇治疗,6例治愈,2例无效后予干扰素联合治疗后瘤体消退,总治愈率100%;经过平均12个月随访,所有患儿无溃疡复发和血管瘤再发。结论:脉冲染料激光治疗婴幼儿体表溃烂型血管瘤,具有良好疗效,是一种行之有效的治疗方法。     

三叶肽：从结构到功能

三叶结构域是一段由38－39个氨基酸组成的多肽序列,其中包含6个高度保守的半胱氨酸残基,这6个半胱氨酸残基以1－5,2－4,3－6的交联方式形成三对二硫,窝囊鑫肽链折叠成特征性的三叶结构。已发现的哺乳动物三叶肽有三种：pS1、SP及ITF。三叶肽通常位于消化道腔面的粘膜层,具有保护和修复功能,在维持粘膜的完整性中发挥着重要作用。     

Critical effect of Helicobacter pylori infection on the effectiveness of omeprazole for prevention of gastric or duodenal ulcers among chronic NSAID users

Background. The recently reported OMNIUM and ASTRONAUT NSAID ulcer prevention trials using omeprazole to prevent endoscopic ulcer recurrence among chronic NSAID users suggested superiority over misoprostol or ranitidine. Aim. To test the hypothesis the results from the OMNIUM and ASTRONAUT studies would not be generalizible as ulcer healing and ulcer recurrence would differ in relation to Helicobacter pylori status. Methods. The data regarding H. pylori status were made available by AstraZenca allowing separate analysis of the outcome of those with NASID ulcers (i.e. without H. pylori infection) and those NSAID use was complicated with the presence of an active H. pylori infection. Results. Reanalysis confirmed that omeprazole was superior to placebo for the prevention of ulcer recurrence in chronic NSAID users. However, overall omeprazole was not significantly better than the subtherapeutic dose (400 µg/day) of misoprostol (14.5% vs. 19.6%, respectively, p = .93); 400 µg of misoprostol was actually superior to omeprazole for the prevention of gastric ulcers among those NSAID ulcers (8.2% vs. 16.6% for misoprostol and omeprazole, respectively; p < .05). Omeprazole was also not statistically different from misoprostol for gastric ulcer prevention in those whose NSAID use was complicated by an active H. pylori infection. Omeprazole was not significantly different from 300 mg of ranitidine for the prevention of NSAID gastric ulcers (14.6% vs. 11.6%, respectively, p = .56). Duodenal ulcers were over represented among H. pylori infected NSAID users and duodenal ulcer prevention was more sensitive to acid suppression than gastric ulcer. Conclusion. The OMNIUM and ASTRONAUT trials may have provided an unrealistic sense of security regarding the effectiveness of omeprazole for protection against ulcer recurrence in chronic NSAID users.     

Purification and Properties of Catalasc from a Methanol-utilizing Yeast,Candida sp. N-16

Defatted soybean extract was fractionated into protein fractions and low molecular weight fractions with gel filtration. NAD-dependent aldehyde dehydrogenase from bovine liver mitochondria and from yeast was found to oxidize aldehyde in both fractions. These enzymes, therefore, were used to determine the quantity of aldehyde. When the protein fraction obtained by gel filtration was subjected to gel filtration again, aldehyde was recovered in the protein fractions. The level of aldehyde in the protein fractions was unchanged before and after digestion of the protein with pepsin. When the soybean extract was incubated beforehand with aldehyde dehydrogenase and NAD⁺ and the subjected to gel filtration, no aldehyde was detected in the protein fractions. These results indicate that aldehyde dehydrogenase acts on the soybean protein-bound aldehyde. Alcohol dehydrogenase from horse liver in the presence of NADH did not convert the bound aldehyde to alcohol.

A large portion of the aldehyde in the extract was separated from the protein by acid precipitation of the protein. Aldehyde dehydrogenase acts on the aldehyde remaining in the protein after acid precipitation. Thus acid precipitation helps to save NAD⁺ required for complete removal of aldehyde from the soybean protein by aldehyde dehydrogenase.     

Eradication of Helicobacter pylori does not reduce the incidence of gastroduodenal ulcers in patients on long-term NSAID treatment: double-blind, randomized, placebo-controlled trial

BACKGROUND: Helicobacter pylori and nonsteroidal antiinflammatory drugs (NSAIDs) are the major causes of gastroduodenal ulcers. Studies on the benefit of eradication of H. pylori in NSAID users yielded conflicting results. OBJECTIVE: To investigate whether H. pylori eradication in patients on long-term NSAIDs reduces the incidence of gastroduodenal ulcers. METHODS: Patients on long-term NSAID treatment and who are H. pylori positive on serologic testing, were randomly assigned to either H. pylori eradication (omeprazole, amoxicillin, and clarithromycin) or placebo. Primary endpoint was the presence of endoscopic gastric or duodenal ulcers 3 months after randomization. RESULTS: One hundred sixty-five (48%) of a total of 347 patients were on gastroprotective medication. At endoscopy, gastroduodenal ulcers were diagnosed in 6 (4%) and 8 (5%) patients in the eradication and placebo group, respectively (p = .65). During follow-up of 12 months, no symptomatic ulcers or ulcer complications developed. No significant differences were found in the development of gastroduodenal erosions, dyspepsia, or in quality of life. CONCLUSION: H. pylori eradication therapy in patients on long-term NSAID treatment had no beneficial effect on the occurrence of ulcers, erosions, or dyspepsia. Ulcer rates in both study arms are remarkably low, in both patients with and without gastroprotective therapy.     

对氯苯丙氨酸对迷走神经刺激诱发溃疡的抑制作用

本研究采用免疫组化结合细胞显微分光扫描测定及图象分析的方法,定位定量观察了对氯苯丙氨酸对大鼠胃粘膜内源性５－羟色胺含量的影响,并进一步探讨了对氯苯丙氨酸抑制迷走神经刺激诱发溃疡的作用。研究结果表明,对氯苯丙氨酸腹腔注射（１００ｍｇ·ｋｇ－１·ｄ－１）后３ｄ,胃粘膜５－羟色胺含量明显下降,细胞显微分光扫描测定及图象分析结果显示给药组５－羟色胺的减少与对照组相差显著。同剂量对氯苯丙氨酸可以减轻迷走神经刺激诱发的溃疡。结果提示,对氯苯丙氨酸可能通过抑制胃内源性５－羟色胺的合成而抑制迷走神经刺激引起的溃疡。     

茄病镰刀菌致小腿慢性溃疡1例报告及病原真菌超微结构的研究

报道1例55岁男性农民,因右小腿溃疡4个月余就诊。取其溃疡组织作真菌培养和病理检查,真菌培养在含氯霉素、放线菌酮和不含氯霉素、放线菌酮的沙堡弱培养基中27℃都长出白色棉絮状菌落,而在不含氯霉素、放线菌酮条件下生长更好;在马玲薯培养基中长出镰刀状大分生孢子,菌种鉴定为茄病镰刀菌。8d后从溃疡处再取标本培养仍为茄病镰刀菌生长。病理切片经银染色后发现念珠状分隔菌丝,用透射电镜对病变组织内的菌体形态进行了超微结构研究。予伊曲康唑口服治疗,但患者未复诊而失访。     

Genetic and evolutionary implications in peptic ulcer disease

The evidence for a genetic component in peptic ulcer disease has been based on twin, family, and blood group studies. A polygenic model for the inheritance of peptic ulcers has been displaced by a genetic heterogeneity model based on several lines of evidence, some of the most powerful being recent work using subclinical markers. One marker in particular, an elevated level of serum pepsinogen I (PG I), a pepsin precursor produced by the gastric mucosa, secreted into the stomach lumen and also appearing in the bloodstream, has been found to be associated with a subgroup of duodenal ulcer patients. Segregation analysis of elevated serum PG I in duodenal ulcer sibships demonstrates familial aggregation consistent with autosomal dominant inheritance. Elevated PG I is also accompanied by gastric hyperacidity and presumably indicates those individuals with an increased mass of chief and parietal cells, and thus an increased capacity for peptic activity, an important element in the pathogenesis of ulcer disease. An evolutionary hypothesis based on selection for peptic activity and acidity is offered to explain several of the epidemiologic and genetic elements of this group of chronic diseases.     

The rabbit antibody response to immunization with Haemophilus ducreyi A comparative study for immunoglobulin detection using diffusion-in-gel enzyme-linked immunosorbent assay, countercurrent immunoelectrophoresis, and double-diffusion-in-gel

Abstract Haemophilus ducreyi was used for immunization of rabbits. The serum level of specific IgG, IgM, and IgA antibodies to the same agent was determined by diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA) and precipitating antibodies were detected with countercurrent immunoelectrophoresis (CIE) and double-diffusion-in-gel (DD) techniques. Antibodies to H. ducreyi could be detected in all rabbits within two weeks with all three techniques used.     

伏立康唑联合手术治愈小腿镰刀菌感染1例

目的探讨串珠镰刀菌致小腿溃疡患者临床及实验室特征。方法多次取患者溃疡分泌物作直接镜检和真菌培养,观察真菌形态学特征。取皮损组织病理活检。结果在马铃薯培养基中25℃培养均长出白色棉絮状菌落,显微镜及扫描电镜下见大分生孢子呈镰刀状,小分生孢子链生和假头状着生并存,在沙堡琼脂25℃和37℃均生长良好,经鉴定为串珠镰刀菌。组织病理学显示为慢性炎性肉芽肿改变,PAS及六胺银染色均未见真菌成分。伏立康唑联合特比萘芬治疗有效,整形外科清创植皮后治愈。结论确诊1例串珠镰刀菌引起的小腿溃疡,伏立康唑联合手术治疗皮肤镰刀菌感染疗效好。     

大鼠脑内5-羟色胺在应激性溃疡形成中的作用

通过神经化学和神经药理学的方法,在大鼠观察了冷冻加束缚应激性溃疡的形成过程中,脑内5-羟色胺(5-HT)的作用。结果如下:1.在应激过程中,脑内5-HT 及其主要代谢产物5-羟吲哚乙酸(5-HIAA)的含量明显升高,特别是5-HIAA 的含量随着应激时间的延长持续上升,说明5-HT 的代谢加快。2.脑内5-HT 或5-HIAA 含量在应激45min 时与溃疡指数呈明显的负相关,而在应激180min 时则与溃疡指数呈明显的正相关。3.侧脑室注射5-HT或其前体5-羟色氨酸(5-HTP),对应激性溃疡的形成呈双重作用,小剂量时减轻而大剂量时加重溃疡的形成。4.腹腔注射5-HT 合成阻断剂对氯苯丙氨酸(pCPA)可降低大鼠脑内5-HT 和5-HIAA 含量,使应激60min 鼠的溃疡形成加重,而使应激180min 鼠的溃疡形成减轻。以上结果提示,在大鼠的冷冻加束缚应激性溃疡的形成过程中,脑内5-HT 起着一定的作用,它很可能在应激早期减轻而在应激晚期加重溃疡的形成。