Helicobacter pylori infection and dental care

Sixty two patients (mean age 45.6 years) were assessed for oral hygiene and periodontal disease by dental examination before endoscopy. Information about oral care, smoking, and dentures was obtained and samples of dental plaque collected. The presence of Helicobacter pylori in plaque as sought by culture and polymerase chain reaction (PCR), and gastric antral biopsy specimens were taken for histological examination. Although H pylori was detected in the antral specimens of 34 patients (54%) all of the cultures of dental plaque were negative, and PCR was only positive from the dentures of one patient. Smokers had poor oral hygiene, visited their dentist less often, and brushed their teeth less frequently. There was no correlation of H pylori gastritis with either dental hygiene or periodontal disease. These results suggest that dental plaque or dentures are not an important reservoir for H pylori and are probably not a significant factor in transmission of the organism. The conflicting results in published works may be caused by differences in sample collection, culture techniques, or oral contamination from gastric juice as a result of gastro-oesophageal reflux at the time of endoscopy.

CT features of pulmonary Mycobacterium avium complex infection

OBJECTIVE

The purposes of this study were to describe and compare the prevalence of disease features in subjects with Mycobacterium avium complex (MAC) disease with those of Mycobacterium tuberculosis infection (MTB), to compare the abilities of CT and chest radiography to identify the features of MAC disease, and to determine if sputum positivity is related to any of the CT features of MAC disease.

METHODS

Computed tomographic scans of 15 subjects with MTB and 55 subjects with MAC were reviewed by 2 observers. Sputum culture results (obtained within 1.9 +/- 2.8 days of scanning) were available in 50 of the 55 subjects with MAC.

RESULTS

Bronchiectasis involving four or more lobes (often associated with centrilobular nodules) was seen only in subjects with MAC. The combination of right middle lobe and lingular bronchiectasis was seen only in MAC (p = 0.015). Thirty-one of the 34 subjects (91%) with MAC who had cavities on CT had a positive sputum culture within 3 weeks of CT, compared with 7 of 12 subjects (58%) without cavities (p = 0.001). Similarly, 36 of 42 subjects (85%) with airspace disease, but only 2 of 8 subjects (25%) without airspace disease grew mycobacteria from their sputa (p < 0.001). Sputum positivity was not associated with the presence of bronchiectasis (p = 0.156) or nodules (p = 0.377).

CONCLUSION

A subgroup of patients with MAC may be distinguished from those with MTB by the presence of widespread bronchiectasis, particularly if it involves the right middle lobe and lingula. Cavities and airspace opacification on CT are associated with positive sputum cultures for MAC.

Cell proliferation in Helicobacter pylori associated gastritis and the effect of eradication therapy

Helicobacter pylori causes chronic (type B) gastritis. The 'intestinal' form of gastric cancer arises against a background of chronic gastritis, and prospective epidemiological studies have shown that H pylori is a major risk factor for this. An increase in mucosal cell proliferation increases the likelihood of a neoplastic clone of epithelial cells emerging where there is chronic epithelial cell injury associated with H pylori gastritis. In vitro bromodeoxyuridine labelling of endoscopic antral biopsy specimens was used to measure mucosal cell proliferation in H pylori associated gastritis before and after therapy for H pylori triple infection. Cell proliferation was increased in H pylori associated gastritis patients compared with normal controls and patients with H pylori negative chronic gastritis (p = 0.0001; Tukey's Studentised range). There was no difference in antral epithelial cell proliferation between duodenal ulcer and non-ulcer subjects infected with H pylori (p = 0.62; Student's t test). Antral mucosal cell proliferation fell four weeks after completing triple therapy, irrespective of whether or not H pylori had been eradicated (p = 0.0001). At retesting six to 18 months later (mean = 12 months), however, those in whom H pylori had not been successfully eradicated showed increased mucosal proliferation compared with both H pylori negative subjects at a similar follow up interval and all cases (whether H pylori positive or negative) four weeks after completion of triple therapy (p = 0.024). These findings suggest that H pylori infection causes increased gastric cell proliferation and in this way may play a part in gastric carcinogenesis.

Cell proliferation in the gastric corpus in Helicobacter pylori associated gastritis and after gastric resection

Patients who have undergone gastric resection are at higher risk of developing gastric carcinoma than normal subjects, and bile reflux is believed to play a role in carcinogenesis. An increase in mucosal cell proliferation increases the likelihood of a neoplastic clone of epithelial cells emerging, particularly where there is chronic epithelial injury associated with bile reflux. Helicobacter pylori is considered a major risk factor for gastric cancer in the intact stomach. It has been shown previously that antral cell proliferation is increased in H pylori gastritis and falls to normal levels after eradication of the organism. Little is known of corpus cell proliferation in H pylori gastritis or after gastric resection. Using in vitro bromodeoxyuridine labelling of endoscopic biopsy specimens we have found that corpus cell proliferation is increased in H pylori gastritis. Cell proliferation was greater in corpus biopsy specimens of resected stomachs than in H pylori gastritis. Subgroup analysis of patients who had undergone gastric resection indicated that those positive for H pylori had higher levels of cell proliferation than those negative for the organism. These findings provide further evidence that H pylori and bile have a role in gastric carcinogenesis and suggest that their presence has a synergistic effect on gastric epithelial cell proliferation.

Automated discrimination and quantification of idiopathic pulmonary fibrosis from normal lung parenchyma using generalized fractal dimensions in high-resolution computed tomography images

RATIONALE AND OBJECTIVES

We computed generalized fractal dimensions for high-resolution computed tomography (HRCT) images to investigate their value in the discrimination and quantification of idiopathic pulmonary fibrosis (IPF) from normal lung parenchyma.

METHODS

A probability distribution that was based on the pixel value in each image was used to compute capacity, information, and higher fractal dimensions for a series of 52 HRCT slices obtained from four patients. Qualitative classification of normal, mild, moderate, and severe IPF cases was achieved by computing the following parameter: DD = D0 - 2D1 + D2, where D0, D1, and D2 represents the capacity, information, and pair correlation dimensions, respectively. A multiple linear regression analysis using morphometric quantification for the set of 52 slices was tested for all possible combinations of the parameters D0, D1, D2, and D3. The generalizability of the model was tested by predicting the extent of IPF for each patient from a regression model computed with the remaining slices in the database.

RESULTS

The best regression results were obtained using the independent parameters D1 and D2 to quantify the extent of diseased lung parenchyma. The technique was tested with 48 slices from 12 new patients. The results indicated that the extent of IPF could be predicted within the confidence limits given by the regression analysis.

CONCLUSION

The extent of IPF can be predicted well within the 90% confidence interval given by the model. The width of the confidence interval decreases as the number of slices used in the linear regression model increases. This operator-independent quantitative technique may be useful in the follow-up of patients with IPF.

CT for asbestosis: value and limitations

CT is more sensitive than clinical evaluation for the detection of asbestosis but is inevitably less sensitive and less specific than pathologic evaluation. For the asbestos-exposed individual, CT is useful for the evaluation of suspected lung masses, particularly rounded atelectasis [15], for identifying pleural plaques, and for confirming unequivocal asbestosis (grade 2 or grade 3 [8]). CT also will identify and quantify emphysema as a cause of physiologic impairment. Because clinicians commonly use CT to resolve clinical uncertainties, radiologists often feel pressured to categorize disease as unequivocally present or absent. Gamsu et al. [8] show that the borderline between normal and abnormal is not always sharply defined. In the absence of pathologic proof, the diagnosis of asbestosis must be based on a thoughtful evaluation of the likelihood of asbestosis by use of all available clinical, physiologic, and radiologic information. The scoring systems used by Gamsu et al. [8] offer a practical approach to defining the likelihood of asbestosis based on CT appearances.

Lipoid pneumonia: CT findings

OBJECTIVE

To assess the CT findings of lipoid pneumonia.

METHODS

Chest radiography and CT performed in six patients with proven lipoid pneumonia were reviewed by two observers. Diagnosis was confirmed by biopsy (five cases) or bronchoalveolar lavage (one case). The clinical history of taking oily substance could be obtained retrospectively in all patients.

RESULTS

Chest radiography showed bilateral air space consolidation in three cases, irregular mass-like lesions in two, and a reticulonodular pattern in one case. Computed tomography demonstrated diffuse parenchymal consolidation in three cases, localized areas of consolidation in two, and subpleural pulmonary fibrosis in one case. In two cases, fat with localized areas of consolidation could be seen on CT. In three cases with diffuse consolidation the attenuation was decreased but higher than that of subcutaneous fat. In one case with subpleural fibrosis no areas of low attenuation could be seen on CT.

CONCLUSION

We conclude that in patients with lipoid pneumonia CT may demonstrate areas with low attenuation diagnostic of fat or areas with nonspecific low attenuation or soft tissue density.

Radiologic findings of adult primary immunodeficiency disorders. Contribution of CT

STUDY OBJECTIVE

We wished to review the chest radiographic and computed tomographic (CT) findings in adults with primary immunodeficiency disorders, and to evaluate the influence of CT on the treatment of these patients.

DESIGN

Retrospective blinded review of radiographs, CT scans, and clinical data.

SETTING

National referral center for immunodeficiency disorders.

PATIENTS

Forty-six chest radiographs and 22 CT examinations of subjects with primary immunodeficiency disorders were independently scored. Nineteen of the subjects who had CT scans had B-cell deficiency, while 3 had T-cell deficiency.

RESULTS

CT-detected bronchiectasis in 15 of 19 subjects with B-cell deficiency, compared with 7 cases detected on chest radiograph. Unsuspected upper lobe bronchiectasis was found on CT in 15 cases. Other CT findings in this group included small nodules in seven subjects, interstitial lines in four, air trapping in seven, ground glass or parenchymal consolidation in nine, evidence of small airways disease in nine, and mucus plugs in four. Two of the three subjects with T-cell disorders showed cavitation and two had unsuspected reactive mediastinal adenopathy. Clinical management appeared to be altered in five subjects with B-cell deficiency by CT findings of severe focal or diffuse bronchiectasis or small airways disease. Additionally, CT localized the bleeding site in three subjects with hemoptysis.

CONCLUSIONS

CT is valuable for detection of bronchiectasis in subjects with B-cell immunodeficiency and may alter treatment of these patients.

Quantitative computed tomography detects air trapping due to asthma

OBJECTIVE

The purpose of this study was to prospectively see if quantitative computed tomography (QCT) could separate asthmatic patients from normal control subjects. The QCT results were also correlated with the pulmonary function tests (PFT) that were done on both the asthmatic patients and control subjects.

SUBJECTS AND METHODS

Eighteen adult nonsmoking asthmatics and 22 adult control subjects were entered into the study. Quantitative CT was performed at the level of the transverse aorta and just above the diaphragm at both end inspiration and end expiration in all patients and control subjects: 10-mm and 1.5-mm collimation using a high spatial frequency algorithm was used to obtain the QCT examinations. The percent of pixels below -900 Hounsfeld units, pixel index, in each of the QCT axial images of the lungs was calculated for each asthmatic and control subject in the study. Pulmonary function testing was performed on both the asthmatics and control subjects and included determination of FEV1, FVC, FRC, RV, and TLC. Unpaired Student's t test analysis of the QCT data was done to statistically compare the asthmatics with the control subjects. Linear regression analysis was done to compare the QCT results with PFT data on the asthmatics and control subjects.

RESULTS

When scans were performed at end expiration, at a level immediately superior to the diaphragm, the mean pixel index was significantly higher in asthmatic subjects compared with normal individuals on both CT (mean for normal subjects 0.16 vs 4.45 for asthmatics, p < 0.004) and high-resolution CT (HRCT) images (mean for normal subjects 1.04 vs 10.03 in asthmatics, p < 0.0001) indicating more areas of low attenuation in asthmatics. The CT and HRCT images from the lower lung zones that were performed at end expiration provided the best separation between the groups. The pixel index on expiration correlated with the degree of air trapping and airflow limitation in the asthmatic group based on FEV1, FRC, RV, and to a lesser extent, FVC.

CONCLUSION

Expiratory QCT is a useful method to assess air trapping in asthmatic patients. The percent of abnormal lung in asthmatics as determined by QCT has a significant correlation with the PFTs that reflect air trapping in asthmatic patients. Quantitative CT may be helpful in assessing degrees of air trapping present in other diseases affecting the airways.

Patient and staff exposure to glutaraldehyde from KeyMed Auto-Disinfector endoscope washing machine

Activated glutaraldehyde (2%) is the recommended agent for disinfection of endoscopic equipment. Exposure to the disinfectant is associated with side-effects and guidelines have been set to avoid these complications. Endoscope washing machines are used to provide automated high level disinfection of endoscopes as well as reduce exposure to the irritant aldehyde. We report a design fault in an endoscope washing machine which results in patients and staff being exposed to activated glutaraldehyde. The Auto-Disinfector (KeyMed) comprises a washing chamber supplied by three separate reservoirs (detergent, disinfectant, and rinse water) via a common channel. After the first cycle endoscopes are processed using previously used detergent and rinse water. Rinse water glutaraldehyde concentrations were measured in four machines during routine endoscopy lists on at least two occasions and showed a progressive rise in glutaraldehyde concentration up to 0.1% after two to six cycles. This results in staff being exposed to glutaraldehyde present on the processed instrument and the disinfectant being pumped from the internal channels of the endoscope into direct contact with the gastrointestinal mucosa during endoscopy at concentrations of 200-1000 ppm. The present atmospheric limit for glutaraldehyde is 0.2 ppm. Skin and mucosal irritation occur at concentrations of 0.3 ppm and severe synovitis in experimental animals at 100 pm. Tongue swelling and bloody diarrhoea with characteristic mucosal histological changes have been reported in patients exposed to activated glutaraldehyde on inadequately rinsed equipment. To reduce this problem the rinse water should be changed after every cycle and the endoscope should be dried thoroughly before use.

Proliferative and constrictive bronchiolitis: classification and radiologic features

The small airways of the lung consist of the terminal bronchioles, respiratory bronchioles, and alveolar ducts. A recently introduced pathologic classification system divides bronchiolitis into proliferative and constrictive types. The histologic classification of small-airways disease into proliferative and constrictive bronchiolitis frequently correlates with the radiographic appearances. Proliferative bronchiolitis is characterized by air-space opacification, whereas constrictive bronchiolitis tends to be associated with lobular areas of decreased attenuation and airway dilatation. The purpose of this essay is to illustrate the radiographic and CT features of these two varieties of bronchiolitis.

Bronchiolitis obliterans: the lone manifestation of rheumatoid arthritis?

The patient was a 62 year old man, who suddenly developed obstructive lung disease without a readily definable cause. He had a remarkable family history of deforming rheumatoid arthritis, and a serum rheumatoid factor of 1:1,256, but with no evidence of active rheumatological disease. Clinical, physiological and radiologic features suggested bronchiolitis obliterans, and this was confirmed by open lung biopsy. Immune staining of tissue revealed immunoglobulin M (IgM) as well as rare immunoglobulin (IgG) containing plasma cells in a peribronchiolar location. Because of these findings, we suggest that this case represents bronchiolitis obliterans secondary to a rheumatoid process. This case is unusual since it appeared in a man and is the first and, so far, the only manifestation of rheumatoid arthritis. Prior studies indicate that the bronchiolitis obliterans of rheumatoid arthritis occurs primarily in women and only in ongoing cases.

Beryllium disease: assessment with CT

PURPOSE

To describe the thin-section computed tomographic (CT) features of beryllium disease and compare the sensitivities of thin-section CT and chest radiography.

MATERIALS AND METHODS

In 28 patients with biopsy-proved beryllium disease and 12 healthy control subjects, radiographs were scored with an international classification system. Thin-section CT scans were scored for 11 parenchymal, airway, pleural, and mediastinal findings.

RESULTS

Thin-section CT revealed at least one abnormality in 25 patients (89%); chest radiography, in 15 patients (54%). After the finding of bronchial wall thickening attributable to tobacco smoking was excluded, CT scans in 21 (75%) of 28 patients were abnormal because of beryllium disease. The most common CT abnormalities were parenchymal nodules (n = 16) and septal lines (n = 14). With use of CT, abnormalities were detected in 10 (77%) of 13 patients with normal radiographs.

CONCLUSION

Thin-section CT was more sensitive than chest radiography in detection of beryllium disease, but the diagnosis was missed in up to 25% of cases with histologic proof.

Comparison of labelling by bromodeoxyuridine, MIB-1, and proliferating cell nuclear antigen in gastric mucosal biopsy specimens

AIMS

To compare proliferating cell nuclear antigen (PCNA) and MIB-1 with bromodeoxyuridine (BrdU) pulse labelling, a specific marker of cell proliferation, in endoscopic gastric biopsy specimens.

METHODS

Twenty four biopsy specimens were obtained from 12 patients: 10 antral and eight body specimens were suitable. Each specimen was routinely processed and stained with haematoxylin and eosin. A modified Giemsa stain was used to detect the presence of Helicobacter pylori. Sections of the specimens were labelled with BrdU, MIB-1, and PC10. Gastric mucosa specimens were divided into three zones. The numbers of positively staining nuclei for 500 epithelial cell nuclei were counted in each zone and expressed as a percentage.

RESULTS

The proportion of PCNA positive cells (range 0-90%) was much greater in all specimens (10 antrum, eight body). BrdU positive cells were virtually all confined to zone 2 (0-17% cells in this zone were positive) (zone 1 = surface and gastric pit, zone 2 = isthmus, zone 3 = gland base), while PCNA positive cells were present in all three zones (1 = 23-90%, 2 = 43-90%, 3 = 0-74%). Spearman's rank coefficient correlation of 0.57 confirmed that the percentage of positively staining cells varied in the same direction for both PCNA and BrdU (p < 0.001). PCNA, however, was overexpressed in all zones of the gastric epithelium compared with BrdU. In 38 biopsy specimens from 19 patients, of which 14 antrum and 11 body were suitable, the proportion of MIB-1 positive cells (0-59%) was greater than BrdU in most. As with BrdU labelling, the MIB-1 positive cells were confined to zone 2 (zone 1 = 1-11%); zone 2 = 21-59%; zone 3 = 0-13%) and the coefficient correlation for MIB-1 and BrdU was 0.63 (p < 0.001).

CONCLUSIONS

MIB-1 accurately reflects the S-phase fraction in gastric mucosa, determined by BrdU labelling in conventionally processed gastric biopsy material. Caution is needed in the interpretation of PCNA labelling detected by PC10, which should not be accepted uncritically as a marker of cell proliferation in paraffin wax embedded material.

Gaucher's disease. An unusual cause of intrathoracic extramedullary hematopoiesis

A thoracic paravertebral mass in an asymptomatic woman with type 1 Gaucher's disease proved to be due to extramedullary hematopoiesis. This is, to our knowledge, the first case of intrathoracic extramedullary hematopoiesis reported with Gaucher's disease.

Imaging of small airways diseases

The idiopathic (BOOP) and secondary forms of proliferative bronchiolitis have similar radiographic appearances. Both are characterized radiographically by patchy airspace disease, which often is peripheral. The radiographic presentation of BOOP may have prognostic significance. In primary or secondary constrictive bronchiolitis, the chest radiograph often is nonspecific, but the CT appearance of patchy, lobular areas of hyperlucency, with or without bronchiectasis, may be diagnostic. Respiratory bronchiolitis usually can be distinguished from IPF on the chest radiograph, and the diagnosis may be suggested on HRCT by the presence of hazy increase in lung density or fine centrilobular nodules.

Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects

A study was undertaken to define the computed tomographic (CT) appearance of the lungs in subjects with uncomplicated asthma and to compare the prevalence of bronchial dilatation at CT in asthmatic and healthy subjects. Clinical features, pulmonary physiologic findings, chest radiographs, and high-resolution CT scans of 48 asthmatic subjects were reviewed. Forty-one (85%) of the 48 asthmatic subjects were undergoing bronchodilator therapy, 28 (58%) were undergoing steroid therapy, and 21 (44%) were cigarette smokers. Twenty-seven healthy control subjects underwent limited high-resolution CT. At selected CT levels, any bronchus with an internal diameter greater than that of the accompanying pulmonary artery was considered dilated. In the asthmatic subjects, 153 (36%) of 429 bronchi evaluated met criteria for bronchial dilatation compared with 37 (26%) of 142 bronchi in the control group (P < .05). Because bronchial dilatation demonstrated at CT did not correlate with clinical data, the authors conclude a bronchus larger in diameter than the adjacent vessel is not sufficient evidence to diagnose cylindric bronchiectasis.

Effect of eradication of Helicobacter pylori on gastric juice ascorbic acid concentrations

Ascorbic acid, the reduced form of vitamin C, may protect against gastric cancer and is secreted by the normal stomach. Secretion is impaired in Helicobacter pylori (H pylori) associated chronic gastritis. This study examined if eradication of H pylori improves gastric juice ascorbate values. Fasting gastric juice and plasma samples were collected at endoscopy from patients participating in trials of H pylori eradication for duodenal ulcer disease and intestinal metaplasia before and up to 15 months after attempted eradication. Ascorbic acid and total vitamin C concentrations were determined by high performance liquid chromatography. In 12 patients in whom H pylori was successfully eradicated gastric juice ascorbate and total vitamin C concentrations and the ratio of juice to plasma vitamin C rose after treatment. Analysis after treatment suggested that the rise was greatest in patients with high final plasma vitamin C concentrations, even though these did not change with treatment. By contrast, in 22 patients in whom H pylori eradication was unsuccessful there were no significant changes in juice or plasma concentrations after treatment. It is concluded that successful eradication of H pylori improves secretion of vitamin C into gastric juice. It is speculated that this increases protection against gastric cancer.

Failure of colonoscopic surveillance in ulcerative colitis

A prospective surveillance programme for patients with longstanding (> = 8 years), extensive (> = splenic flexure) ulcerative colitis was undertaken between 1978 and 1990. It comprised annual colonoscopy with pancolonic biopsy. One hundred and sixty patients were entered into the programme and had 739 colonoscopies (4.6 colonoscopies per patient; 709 patient years follow up). Eight eight per cent of examinations reached the right colon. There was no procedure related death. One Dukes's A cancer was detected. Forty one patients (25%) defaulted. Of these 25 remain well; 13 are unaccounted for, and one died from colonic cancer. One patient had colectomy for medical reasons, and another died of carcinoma of the pancreas. Retrospectively an additional 16 eligible patients were identified who had not been recruited. Of these, 14 remain well, two are unaccounted for. None developed colonic cancer. Four patients refused colonoscopy. All remain well. Over the same period seven other cases of colonic cancer were found in association with ulcerative colitis, two in patients who had erroneously been diagnosed as having only proctitis and were therefore not entered into the programme, but were found at operation to have total colitis, one in a patient with colitis of seven years duration, and four patients who had previously attended the clinic but had been lost to follow up before 1978 and then had represented with new symptoms during the surveillance period. Thus, of the nine colitis related cancers diagnosed in this centre during the study period only one was detected by the surveillance programme. The results of this large study, a a review of published works, cast doubts on the effectiveness of colonoscopic surveillance programmes in detecting colorectal cancer in patients with ulcerative colitis.

Pulmonary capillaritis. The association with progressive irreversible airflow limitation and hyperinflation

We report two patients with systemic necrotizing vasculitis (microscopic polyarteritis) and associated recurrent pulmonary capillaritis, in whom progressive irreversible airway dysfunction began approximately 10 yr after disease onset. Their course was characterized by repeated episodes of diffuse alveolar hemorrhage, glomerulonephritis, palpable purpura, and splinter hemorrhages. The lung revealed intraalveolar hemorrhage, neutrophilic infiltration and cellular fragmentation, fibrinoid necrosis of the alveolar interstitium, and parenchymal hemosiderin deposits. No medium-sized vessel involvement, granulomatous inflammation, or bronchiolar obliteration were seen. Renal biopsies revealed focal segmental necrotizing glomerulonephritis, and a cutaneous biopsy in one case showed a leukocytoclastic vasculitis. Immunofluorescent studies of lung and kidney showed minimal or no immunoreactivity. The clinical course and serologic tests did not support another systemic vasculitis, connective tissue disease, or antiglomerular basement membrane antibody disease. The acute episodes responded to antiinflammatory and immunosuppressive therapy. Symptoms, serial pulmonary function tests, and chest imaging documented the development of a progressive irreversible obstructive airway disease. No other predisposing factors were identified. These cases demonstrate the unexpected appearance of an irreversible obstructive airway disease with lung parenchymal hyperinflation after systemic necrotizing vasculitis associated with recurrent pulmonary capillaritis and diffuse alveolar hemorrhage.

Identification of Helicobacter pylori DNA in the mouths and stomachs of patients with gastritis using PCR

AIMS

To determine the prevalence of Helicobacter pylori colonisation in the mouths of patients with H pylori gastritis.

METHODS

A nested polymerase chain reaction test for the 16S ribosomal RNA gene of H pylori was used on saliva, dental plaque, gastric juice and gastric biopsy specimens from patients attending a dyspepsia clinic.

RESULTS

Thirteen patients had histologically confirmed Helicobacter associated gastritis. Twelve of these had positive gastric aspirates by PCR. Five had at least one positive oral specimen. Eight patients with normal gastric biopsy specimens had no PCR positive oral specimens or gastric aspirates. All, however, had PCR positive gastric biopsy specimens. In an attempt to determine the origin of these positive results in normal patients, it was shown that biopsy forceps could contaminate specimens with DNA from previous patients.

CONCLUSION

The demonstration of the organism in the mouths of a substantial proportion of dyspeptic patients has major implications for the spread of H pylori and identifies a potential source for reinfection following eradication of the organism from the stomach.

Correlation between high resolution computed tomography and tissue morphometry of the lung in bleomycin-induced pulmonary fibrosis in the rabbit

It is generally considered that the hazy increased density and consolidation seen on high resolution lung CT (HRCT) scans in patients with diffuse interstitial lung disease reflect tissue inflammation, whereas a predominance of linear structures corresponds to tissue fibrosis. The purpose of this study was to determine whether abnormalities observed by HRCT in the lungs of bleomycin-treated rabbits correlated with specific pathologic abnormalities seen on morphometric analysis of lung tissue. Bleomycin was instilled into the lungs of intubated rabbits and followed by inhalation of 100% oxygen. In different animals on Days 14, 28, or 56 after bleomycin, 1 or 1.5 mm HRCT scans were obtained at 8-mm intervals. Subsequently, the right lungs were processed for histology, and the left lungs were processed for determination of hydroxyproline content. Using a morphometric technique, the volume density of normal lung parenchyma, hazy increased density, consolidation, nodules, and central or peripheral lines was determined on each HRCT scan. After the rabbits were killed, the volume density of normal lung parenchyma, intra-alveolar cells, intra-alveolar amorphous material, and thickened interstitium (cellular or acellular) was also determined morphometrically in multiple lung tissue sections in each rabbit. There was a correlation between the volume densities of consolidation on HRCT scans and intra-alveolar cells and amorphous material on tissue morphometry (r = 0.90, p = 0.0001) over the 56-day period after bleomycin/oxygen administration. There was no correlation between the volume density of hazy increased lung density (HRCT) and the volume density of these same or any other individual or combined parameters (tissue morphometry) over the 56 days.(ABSTRACT TRUNCATED AT 250 WORDS)