Effects of repeated injection sclerotherapy on acid gastroesophageal reflux

Acid gastroesophageal reflux was determined by long-term pH monitoring in 19 consecutive variceal bleeders after 5 to 20 (mean, 10.3 +/- 1 SEM) sclerotherapy sessions with the flexible endoscope using polidocanol 1% as sclerosant. Fifteen cirrhotics with untreated varices served as controls. Percentage time of esophageal pH less than 4 (3.3 +/- 0.7 SEM vs. 5.2 +/- 2.2 in the controls) and mean duration of reflux episodes (2.9 +/- 0.4 vs. 3.0 +/- 0.7 min) showed no significant differences between both groups. The findings indicate that repeated injection sclerotherapy with the flexible endoscope does not lead to an enhancement of acid gastroesophageal reflux.

Fragmentation of gallstones by extracorporeal shock waves

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.

Comparison of the therapeutic effect of wheat bran, mebeverine and placebo in patients with the irritable bowel syndrome

There is no generally accepted treatment in the irritable bowel syndrome (IBS), probably because of a lack of convincing therapeutic trials. In the present study, 120 outpatients with IBS participated in a prospective randomized therapeutic trial. According to a double-blind design, 40 patients received 400 mg/day mebeverine and 40 patients received a placebo. In an open branch of the trial, 40 patients were treated with 15 g/day wheat bran. The effects of treatment on symptoms were noted after 4, 8, 12 and 16 weeks of therapy. A significantly superior symptomatic effect of bran in comparison to mebeverine and placebo was demonstrated after 12 weeks, but could not be confirmed at the end of the study. There was no significant difference between the symptomatic effect of mebeverine and placebo. The compliance with the therapy was about 80% for 4 weeks, but dropped to about 50% at the end of the trial. This points to a particular difficulty in the management of patients with IBS. The results of this trial suggest that bran and mebeverine are no ideal therapy for patients with IBS but they support the therapeutic use of bran in patients with IBS.

Bacteriaemia associated with endoscopic sclerotherapy of oesophageal varices

Studies on the incidence of bacteraemia following endoscopic injection sclerotherapy produce equivocal results. Accordingly, we performed a prospective study in 24 patients who underwent a total of 40 sclerotherapy sessions. Blood was drawn before, during, and 5 minutes, 30 minutes, 3 hours and 24 hours after sclerotherapy. Transient bacteraemia (mostly during and 5 minutes after sclerotherapy) was detected in 21 (53%) procedures. The bacteraemic events bore no relation to febrile episodes. The most frequently isolated microorganisms were alpha-haemolytic Streptococcus spp. and coagulase-negative Staphylococcus spp.. We conclude that injection sclerotherapy is associated with a high incidence of bacteraemia which, however, in most cases is transient and does not lead to septic disease.

Suppressor mutations identify box9 as a central nucleotide sequence in the highly ordered structure of intron RNA in yeast mitochondria

Data presented here lend support to the notion that RNA splicing in yeast mitochondria depends on the formation of hybrid structures involving the well-conserved intron sequences box9 and box2. Starting with the cis-dominant splicing-defective box2 mutant G2590, a G----A transition, we isolated a revertant having a mitochondrial second site suppressor mutation, which restores splicing competence in the presence of the original mutation. Sequence analysis reveals that the suppressor mutation is a C----T transition in box9(5' part). This second mutation compensates for the first one in box2 and restores a box2/box9(5') hybrid. Combined with previous data demonstrating an interaction of the adjacent sequence box9(3' part) with the upstream box9c sequence in intron 4, the central role of box9 in the formation of the intron 4, the central role of box9 in the formation of the intron 4 RNA high order structure becomes evident.

A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease

Irritable bowel syndrome is a very common clinical problem for which there are no established diagnostic criteria. The two aims of the present study were first, to create a scoring system for the diagnosis of irritable bowel syndrome incorporating features from the case history, physical examination, and some basic investigations including erythrocyte sedimentation rate and blood count; and second, to estimate the diagnostic accuracy of this scoring system in terms of its sensitivity and specificity, and of its predictive value in patients diagnosed as having irritable bowel syndrome by conventional methods. A group of 479 consecutive outpatients referred to a gastrointestinal clinic was studied by the usual extensive routine workup practiced at the clinic, including numerous laboratory tests, endoscopy of upper and lower gastrointestinal tract, and ultrasound. In 209 patients, symptoms were related to an underlying organic disease and in 108 patients irritable bowel syndrome was diagnosed without any recognizable organic disease. As a separate exercise, a scoring system including the answers of a questionnaire and the results of eight basic investigations was established. After completion of the study, the score was weighted by means of a logistic regression analysis. Using the weighted score, at a sensitivity of 64%, the specificity for the diagnosis of irritable bowel syndrome was 99%, and at a sensitivity of 83%, the specificity was 97%. Patients with organic diseases such as malignant tumor or inflammatory bowel disease were well discriminated by the score. It is concluded that a detailed history, physical examination, and basic laboratory tests are sufficient in most patients for the positive diagnosis of irritable bowel syndrome and the exclusion of any underlying organic diseases.

Processing of yeast mitochondrial RNA: involvement of intramolecular hybrids in splicing of cob intron 4 RNA by mutation and reversion

Revertants have been obtained from six mutants of the box9 cluster, which are supposed to be defective in RNA splicing as a result of alterations in a splice signal sequence. This sequence is in the 5' part of intron 4 of the cob gene, 330 to 340 bp downstream from the 5' splice site. Sequencing reveals that reversion to splicing competence is achieved by restoration of the wild-type box9 sequence; by creation of novel box9 sequences; and by introduction of a second site or suppressor mutation (sup-) compensating for the effect of the primary box9- mutation. The sup- mutation alters a sequence in intron 4,293 bp upstream from the box9- primary mutation. The box9 sequence and this upstream sequence can base pair to form an intramolecular hybrid in intron RNA in which box9- and sup- are compensatory base pair exchanges (G----A and C----U, respectively). Thus intramolecular hybrid structures of intron RNA are essential for RNA splicing.

[Hepatitis risk to dentists. Studies on the frequency of hepatitis in dentists in the Munich region and in the district of Upper Bavaria]

Dentists have a particular risk of acquiring viral hepatitis because of their close contact with blood and saliva during dental manipulations--especially as the majority of dentists do not use gloves during work and often have small cuts and abrasions on their hands. On the other hand personnel in the dentist's office offers several potential modes of parenteral and oral-intestinal transmission of hepatitis. In order to find out the risk of dentists exposing themselves to hepatitis-infection (especially hepatitis B-infection) we performed a questionnaire-study among practicing dentists all over Oberbayern. 858 replies were received after distribution of 1030 questionnaires (participation: 83.3%) and could by analyzed. 116 dentists had had a hepatitis during their professional work (13.5%). The frequency of hepatitis among the younger colleagues--who were practicing from 1 to 14 years--was about 5%. The number of hepatitis-infections increased continually up to 33% after 35--39 years of professional activity. In a second study blood samples were taken from 773 dentists and were tested for HB3Ag by radioimmunoassay. Of these 773 blood samples taken 25 (3.5%) were found to be antigen-positive. Compared to the general population the risk of infection is 6- to 30 times higher in dentists. The challenge of hepatitis-virus-infection can at present be met only-and at least in part-by scrupulous attention to prophylactic measures, such as using disposable gloves, needles and syringes and in autoclaving all non-disposable equipment. Besides dental personnel and patients should be screened at regular intervals for the presence of HBsAG.

[Gamma globulin therapy of acute viral hepatitis. Studies on the therapeutic effect of gamma globulin on the course and late prognosis of manifested acute viral hepatitis in man]

In a prospective study 148 consecutive patients with biopsyproved acute viral hepatitis were observed serially and followed for 5 years. They were divided into three groups on the basis of being treated with high or low doses of gamma globulin and compared with a control group, not treated. As the efficacy of gamma globulin for the prophylaxis or modification of infectious hepatitis has been well documented by many investigators during the past 25 years, we were interested in evaluating the therapeutic effect of gamma globulin on the course of viral hepatitis. The purpose of the study was to determine the comparative efficacy of various doses of gamma globulin in preventing complications and in influencing the severity and the length of time of acute viral hepatitis and in preventing the development of chronic hepatitis and cirrhosis. For controlling the clinical, biochemical and histopathologic course 12 functional parameters were repeatedly measured under stable clinical conditions and 3--12 liver biopsies were performed in an individual patient using the Menghini needle with an intercostal approach. During the 5-year trial an overall of 825 liver biopsis were performed with this 148 patients. We conclude from this study, that in about 80% of patients with acute viral hepatitis recovery is complete, but takes several month's. A protracted course of 4 month's duration until recovery was found in 45 patients (30,4%), persistent hepatitis with recovery after 1--4 years duration occurred in 37 patients (25%), global liver necrosis with hepatic coma in 3 (2,3%), chronic hepatitis in 22 (14,8%), 8 of them as chronic aggressive hepatitis and cirrhosis in 3 (2,3%). The study demonstrated no therapeutic efficacy of gamma globulin in modifying the course or preventing complications of both AuAg+ and AuAg-neg. acute viral hepatitis in man. There was no striking difference in the groups treated with various doses of gamma globulin compared with a control group.