Registration of surface fluorescence of endogenous porphyrins during low-level laser therapy of gastric and duodenal ulcers

With the use of the developed opto-fiber spectroscope and gastroscope, the intensity of fluorescence from the ulcer surface into the gastrointestinal tract was measured in the range of 670-690 nm under the He-Ne laser (= 632.8 nm) illumination. Surface fluorescence data were collected with the use of a special diagnostic fiber with a total diameter of about 2 mm, which combines some illuminating and receiving fibers. To do the measurements, the diagnostic fiber was brought into a slight contact with the mucosa surface. The quantitative results were calculated with the use of the special fluorescent contrast coefficient (Kf), which takes into account the backscattered light as well. After the fluorescent diagnostic procedure, the low-level laser therapy was applied to all patients. It was found that: first of all, during the laser medical cure the registered fluorescence for the patients with a good dynamics of treatment had an evident tendency to a decrease, and the coefficient Kf for observed ulcers tended to approach the value obtained from normal mucosa (Kf), which indicates the normalization of the porphyrin content in the tissue. Second, the retrospective analysis of the efficacy of laser therapy versus initial values of Kf showed that, for the patients with the initial values Kf = 0.2, the efficiency of the laser treatment was the highest: the relation between the patients with good treatment results and bad ones was 4:1 (more than 80%). For the initial Kf = 0.2-0.3, this relation was 3:1 but for Kf = 0.4-0.5 it was 2:3. The differences in the efficiency of the low-level laser therapy, except the cases of the cancer in the ulcers, may be due to different content of porphyrin in the tissue: at high concentrations of the photosensitizer in the ulcer, the effect of the overdosing could be realized. In this case, another technology of laser illumination is needed. The results are discussed in terms of the free-radical conception of the stimulating effect of laser radiation.     

Effects of melatonin and tryptophan on healing of gastric and duodenal ulcers with Helicobacter pylori infection in humans

Melatonin (MT) and its precursor L-tryptophan (TRP) are implicated in the protection of gastric mucosa against aspirin-induced lesions and in the acceleration of healing of idiopathic gastro-duodenal ulcers, but no information is available whether these agents are also effective in healing of gastroduodenal ulcers accompanied by Helicobacter pylori (H. pylori) infection. In this study three groups A, B and C, each including 7 H. pylori-positive patients with gastric ulcers and 7 H. pylori-positive patients with duodenal ulcers, aging 28-50 years, were randomly assigned for the treatment with omeprazole 20 mg twice daily combined with placebo (group A), MT administered in a dose of 5 mg twice daily (group B) or TRP applied in a dose of 250 mg twice daily (group C). All patients underwent routine endoscopy at day 0 during which the gastric mucosa was evaluated and gastric biopsies were taken for the presence of H. pylori and histopathological evaluation. The rate of ulcer healing was determined by gastroduodenoscopy at day 0, 7, 14 and 21 after the initiation of the therapy. Plasma MT, gastrin, ghrelin and leptin were measured by specific RIA. At day 21, all ulcers were healed in patients of groups B and C but only 3 out of 7 in group A of gastric ulcers and 3 out of 7 in duodenal ulcers. Initial plasma MT showed similar low levels in all three groups but it increased several folds above initial values in ulcer patients at day 7, 14 and 21. Plasma gastrin and leptin levels showed a significant rise over initial values in patients treated with omeprazole and placebo, MT or TRP while plasma ghrelin levels were not significantly affected by these treatments. We conclude that MT or TRP added to omeprazole treatment, significantly accelerates healing rate of H. pylori infected chronic gastroduodenal ulcers over that obtained with omeprazole alone and this likely depends upon the significant rise in plasma MT and possibly also in leptin levels, both hormones involved in the mechanism of gastroprotection and ulcer healing.     

Emergency Vagotomy and Pyloroplasty for Perforated Duodenal Ulcer: Study of 73 Cases

Seventy-three unselected patients with perforated duodenal ulcer were treated by vagotomy and pyloroplasty in a six-year period. Postoperative complications were commoner when the operation was carried out after more than six hours after perforation. The follow-up results were similar to those for elective vagotomy and pyloroplasty carried out in the hospital during the past nine years.     

Scalene node biopsy; an analysis of 42 cases

Scalene node biopsy was done in 42 patients with previously undiagnosed intrathoracic lesions. A definite histologic diagnosis was obtained in 25 patients. Scalene node biopsy is not only a valuable diagnostic procedure for intrathoracic lesions, but many times it may obviate the necessity of exploratory thoracotomy. If a diagnosis of carcinoma of lung is established by scalene node biopsy, the operability of the patient and the type of pulmonary resection should be carefully evaluated.