Hemodynamic and metabolic changes following cerebral revascularization in patients with cerebral occlusive diseases

Changes in cerebral hemodynamics and metabolism following cerebral revascularization were evaluated using positron emission tomography (PET). Ten patients who had received nonsurgical treatment for 3-6 months for minor completed stroke underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery. All patients showed no extensive infarction on MR, and responsible vascular lesions were detected in the anterior circulation. A PET study of cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate for oxygen (CMRO2), and cerebral metabolic rate for glucose (CMRGlu) measurements was performed before and 1.5 months after surgery using a steady state technique. Angiographically, anastomotic sites were patent in all patients. Seven patients showed neurological improvement after surgery and the others showed no improvement. The decreases in CBF, CMRO2 and CMRGlu recovered to some extent not only on the lesion side but also on the contralateral side after surgery. The increase in OEF values on the lesion side subsequently decreased after surgery. CMRO2 and CMRGlu showed parallel changes. It is concluded that the metabolic improvement afforded by the cerebral revascularization resulted in the neurological improvement, and that PET study is a powerful method for evaluating patients with cerebral occlusive diseases.

Bile duct wall thickness measured by intraductal US in patients who have not undergone previous biliary drainage

BACKGROUND

We investigated the bile duct wall thickness measured on intraductal US in patients who had not undergone biliary drainage, with special attention to the influence of cancer at the distal bile duct, bile duct stones, obstructive jaundice, longitudinal cancer extension, and primary sclerosing cholangitis on wall thickness.

METHODS

The study included 183 patients. Patients who had undergone previous biliary drainage were excluded. Intraductal US was performed by the transpapillary route with use of a thin-caliber ultrasonic probe (2.0 mm diameter, 20 MHz frequency). The bile duct wall thickness (width of the inside hypoechoic layer) was retrospectively measured on US images.

RESULTS

Bile duct wall thicknesses of the common hepatic duct for the control group (n = 95), cancer at the distal bile duct group (n = 9), bile duct stone group (n = 56), and obstructive jaundice group (n = 17) were 0.6 +/- 0.3 mm (mean +/- SD), 0.8 +/- 0.5 mm, 0.8 +/- 0.6 mm, and 0.8 +/- 0. 5 mm, respectively. No significant differences (p > 0.05) were found between them. However, wall thickness for the cancer extension to the common hepatic duct group (n = 4, 2.0 +/- 0.4 mm) and sclerosing cholangitis group (n = 2, 2.5 +/- 0.4 mm) were significantly greater than in the other groups (p < 0.005).

CONCLUSIONS

In patients who have not undergone previous biliary drainage, the bile duct wall thickness was not thicker in patients with obstructive jaundice. However, the duct wall was significantly thicker in patients with either longitudinal cancer extension or primary sclerosing cholangitis compared with that of other groups.

Influence of bile duct diameter on the therapeutic quality of endoscopic balloon sphincteroplasty

BACKGROUND AND STUDY AIMS

Endoscopic balloon sphincteroplasty (EBS) has been reported to be a safe alternative to sphincterotomy for the treatment of bile duct stones. We evaluated the factors which influence the therapeutic efficacy of EBS.

PATIENTS AND METHODS

A total of 118 consecutive patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography (ERC), EBS was done using a biliary dilation catheter (balloon diameter, 8mm). The duct was then cleared using Dormia baskets or retrievel balloon catheters. When the stones were greater than 8 mm in diameter, mechanical lithotripsy was performed before extraction. Complete stone clearance was assessed by balloon-ERC and intraductal ultrasonography. Therapeutic efficacy was assessed using univariate and multivariate analysis. Patients were classified into three groups according to the bile duct diameter: nondilated (bile duct < or = 10 mm), mildly dilated (10 mm < bile duct < or = 15 mm), and severely dilated group (bile duct > 15 mm).

RESULTS

In 113 of 118 (96%) patients, the stones were completely cleared with one to six endoscopic sessions (mean 1.6 sessions). In the nondilated group, 24 of 28 (85%) patients were cleared of stones in one session (mean 1.2 sessions), without the use of mechanical lithotripsy in 23 of 28 (82 %) patients. In the mildly dilated group, 23 of 38 (61 %) patients were cleared of stones in one session (mean 1.5 sessions). In contrast, in the severely dilated group, only 16 of 52 (31 %) patients were cleared of stones in one session (mean 2.0 sessions). Stone size, number of stones, and use of mechanical lithotripsy were independent variables which influenced the success of stone clearance in one session after EBS.

CONCLUSION

When EBS is done in patients with bile duct stones, bile duct diameter may be a good indicator of therapeutic efficacy. In patients with severely dilated bile ducts (> 15 mm), EBS is of limited effectiveness.

Response of cerebral oxygen metabolism in the head-up position during laparoscopic cholecystectomy

To clarify the influence of the head-up position on cerebral oxygen metabolism during laparoscopy with CO2 insufflation in 12 patients who underwent laparoscopic cholecystectomy, changes in the concentrations of cerebral oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), total hemoglobin (total Hb) and oxidized cytochrome aa3 (Cyt aa3) were measured by use of near-infrared laser spectroscopy. Anesthesia was maintained with nitrous oxide (66%), oxygen, and sevoflurane. Pneumoperitoneum was maintained at an intraabdominal pressure of 10-12 mm Hg by use of CO2. Minute ventilation was adjusted to maintain end-tidal CO2 tension (P(ET)CO2) between 35 and 40 mm Hg during the procedure. Patients were moved from supine to the head-up (20 degree) position before intraabdominal manipulation. The concentration of HbO2 decreased significantly when patients were moved to the head-up position and 30 min thereafter. It remained significantly low after they were returned to the supine position and at the end of surgery. The concentration of Hb was unchanged during the study. Therefore, the concentration of total Hb decreased significantly when patients were moved to the head-up position, as well as 30 min thereafter. It remained significantly low after they were returned to the supine position and at the end of surgery. The concentration of Cyt aa3, however, did not change significantly during the study. These results suggest that the head-up position during laparoscopic cholecystectomy decreases cerebral HbO2 and total Hb.

[Intraoperative CT imaging system using a mobile CT scanner gantry mounted on floor-embedded rails for neurosurgery]

Many neurosurgeons prefer to use intraoperative computed tomographic (CT) scanning, when possible, to check whether there is residual lesion or unexpected bleeding. We report a practical intraoperative CT imaging system using a high-speed CT scanner installed in the operating room along with a digitally controlled neurosurgical operating table. We designed a rail-track system to mobilize the CT gantry. The gantry is fixed onto a motorized carrier that can be moved smoothly on a rail-track embedded in the floor and with a maximum reach of 2.85 m from the room's wall to the operating table. The longitudinal motion of the operating table is easily adjusted by a foot switch from manual control to automatic control directly from the CT scanner's computer like an ordinary CT scanner bed in increments of 2, 5 or 10 mm during CT scanning. Either a carbon-made radiolucent head frame or carbon-made head plate is used as a headrest. Using this CT scanner system, pre- and intraoperative CT scannings were performed on 46 patients with brain tumors, cervical lesions or other intracranial lesions. We could operate on the patient with enough working space between the mobile CT gantry and the operating table for microneurosurgery. We could obtain intraoperative CT imaging of a patient on the operating table while the surgical wound remained open, the surgical drapes kept in place, and the surgical position unchanged, saving time in intraoperative CT scanning and preparation for further surgery when needed. This intraoperative CT imaging system installed in the operating room should be useful for neurosurgery.

Portal imaging by intravenous three-dimensional computed tomography after pancreaticoduodenectomy: a report of four cases

By employing three-dimensional computed tomography (CT) for portography, we analyzed the portal vein changes during the initial stage after a pancreaticoduodenectomy (PD), which seemed to affect postoperative complications. Four patients underwent PD without portal vein reconstruction with a standard radical lymph node dissection for cancer of the pancreaticoduodenal area. A total of 140 ml of contrast medium was intravenously injected at 2.5 ml/s, and imaging was started after 65s with a Hitachi W-2000 CT scanner. Three-dimensional portal vein images were then reconstructed by the Voxel Transmission method. Three-dimensional CT showed portal stenosis in our all patients from the first to the third week after PD. In three of the patients, stenosis disappeared by week 7, 8, or 15, respectively, without the formation of a bypass. In three patients, portal vein stenosis was severe while in one patient, it was mild. Severe complications such as gastrointestinal hemorrhaging and hepatic abscess occurred in two patients with severe portal stenosis. The onset of portal stenosis might therefore affect postoperative complications after PD.

Development of bioactive bone cement and its clinical applications

This paper is a summary of already published papers on the bioactive bone cement (BA cement) which consists of CaO-SiO2-P2O5-MgO-CaF2 (AW glass-ceramic) powder and bisphenol-a-glycidyl methacrylate (Bis-GMA) resin. Two types of BA cement, dough and injection type, were prepared by changing their chemical compositions slightly. They harden in a few minutes exhibiting much lower curing temperature than PMMA cement. They have significantly higher compressive, bending, and tensile strengths than PMMA cement and have a character of bonding directly with bone in 4-8 weeks in vivo. Intercalary prosthetic replacement of the femur and total prosthetic replacement of the hip were performed in dogs using either PMMA cement or BA cement. Mechanical tests demonstrated that fixation strengths of these prostheses with BA cement increased with time and were significantly greater than those with PMMA cement tested at any time. Results of histological examinations showed direct bonding between BA cement and bone, and that the bone trabeculae around BA cement mantle grew with time, while with PMMA cement an intervening soft tissue layer was always observed at the cement-bone interface. BA cement was used in a few aged patients to install a hip prosthesis either in cases of revision or femoral neck fracture. The longest follow-up period of the patient is 4 yrs. The patients have been doing well with no adverse effect of the cement to date.

Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine

This study analyzed the postoperative results of surgical treatment for thoracic and cervicothoracic myelopathy caused by ossification of the posterior longitudinal ligaments (OPLL) or ossification of the yellow ligaments (OYL) in 22 patients using magnetic resonance imaging (MRI), myelography and computed tomography (CT). Anterior procedures were performed in 11 patients for OPLL, while posterior approaches were adopted for the management of 11 patients for both OYL and OPLL combined with OYL lesions. Clinical symptoms were improved using both anterior and posterior techniques. MRI and myelo-CT studies, which show the direction of cord compression, the form and extent of the lesion, and the degree of thoracic kyphosis, are very useful when the surgical procedure for OPLL and OYL in the thoracic and cervico-thoracic spine is selected.

Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy

BACKGROUND

We determined the accuracy of intraductal ultrasonography (IDUS) in distinguishing between bile duct cancer and benign bile duct disease.

METHODS

Patients (n=42) who required bile duct biopsy using percutaneous transhepatic cholangioscopy (PTCS) to evaluate bile duct strictures or filling defects were studied. A thin-caliber ultrasonic probe (2.0 mm diameter and 20 MHz frequency) was inserted into the bile duct, and its images were prospectively reviewed before PTCS.

RESULTS

Disruption of the bile duct wall structure, seen on IDUS, was associated with malignancy in 25 of 26 patients. When IDUS demonstrated a lesion with normal bile duct structure, six of nine patients were found to have no malignancy. IDUS demonstrated no intraductal lesion in seven patients, and bile duct biopsy also did not indicate cancer in any of these patients. The accuracy, sensitivity, and specificity of IDUS for diagnosing bile duct cancer were 76%, 89%, and 50%, respectively. When used in tandem with IDUS, the sensitivity of bile cytology (64%) and PTCS (93%) improved to 96% and 100%, respectively.

CONCLUSIONS

The accuracy of IDUS for diagnosing bile duct cancer was less than that of PTCS (95%). However, the sensitivity for bile cytology, or bile duct biopsy improved when performed in combination with IDUS.

Biopsy sites suitable for the diagnosis of Helicobacter pylori infection and the assessment of the extent of atrophic gastritis

OBJECTIVES

We performed this study to determine which biopsy sites in the stomach are suitable for the diagnosis of Helicobacter pylori infection and the assessment of the extent of atrophic gastritis.

METHODS

Endoscopy was performed in 76 H. pylori-positive patients with histologically confirmed chronic gastritis. Biopsies were taken from the following six sites: the lesser curvatures of the mid-antrum (site 1), the angulus (site 2), the middle body (site 3), and the greater curvatures of the mid-antrum (site 4), the angulus (site 5), and the middle body (site 6) of the stomach. The extent of atrophic gastritis was assessed endoscopically as well as histologically, and patients were classified into five groups according to its extent. H. pylori status was assessed histologically. The histological severity of inflammation, activity, atrophy, and intestinal metaplasia was assessed according to the Updated Sydney System. The grades of these items were compared among the six biopsy sites in each group of patients.

RESULTS

Site 6 was most reliable for the diagnosis of H. pylori infection, and site 4 was suitable for examining the status of H. pylori colonization in the antrum. Site 1, site 3, and site 6 were suitable for the assessment of the extent of atrophic gastritis.

CONCLUSIONS

Our results indicate that for an accurate diagnosis and assessment, biopsies should be taken from the following four sites: the lesser curvatures of the mid-antrum (site 1) and middle body (site 3), and the greater curvatures of the mid-antrum (site 4) and middle body (site 6) of the stomach.

Sonographic diagnosis of small intestinal anisakiasis

PURPOSE

We studied the utility of sonography in the early diagnosis of anisakiasis of the small intestine.

METHODS

The imaging findings and clinical data of 12 patients with proven small intestinal anisakiasis were retrospectively reviewed.

RESULTS

Dominant sonographic findings were ascites, small bowel dilatation, and focal edema of Kerckring's folds.

CONCLUSIONS

Patients who have acute abdomen after recent ingestion of seafood and in whom ascites, small bowel dilatation, and focal edema of Kerckring's folds are seen by sonography should be suspected of having small intestinal anisakiasis and should be treated conservatively without laparotomy.

Microwave coagulation therapy on hepatomas: CT and MR appearance after therapy

Laparoscopic microwave coagulation (LMC) for hepatocellular carcinomas (HCCs) was performed on 26 HCCs in 17 patients. Contrast-enhanced CT (CECT) and MR images (T1-weighted imaging [T1WI], T2WI, gadolinium-diethylenetriamine pentaacetic acid [Gd-DTPA] T1WI) were obtained to determine changes over time. The irradiated center exhibited low to moderate intensity with surrounded high intensity (HI) on T2WI and Gd-DTPA T1WI. On T1WI, lesions showed four patterns of intensity: uniform HI (30.8%), arcuate HI (26.9%), mainly low with spot HI (30.8%), and isointensity to hypointensity (11.5%). Follow-up imaging at more than 170 days revealed isointensity to hypointensity on T1WI (96.2%) and reduced HI on T2-weighted imaging (T2WI) and Gd-DTPA T1WI. All lesions became less conspicuous and were reduced in volume. HCC shows time-related changes in signals and size after LMC. Identifying the irradiated lesion is necessary to estimate the adequacy of treatment by comparison with the pretherapeutic image.

A pilot study on modified endoscopic variceal ligation using endoscopic ultrasonography with color Doppler function

OBJECTIVE

The purpose of the study was to evaluate feasibility of modified endoscopic variceal ligation (EVL), namely the "intensive ligation" method, using endoscopic ultrasonography with color Doppler function (EUS-CD).

METHODS

Forty-five patients with esophageal varices were treated by modified EVL. Variceal hemodynamics in 38 patients were examined using EUS-CD, which showed abdominal hemodynamics in detail under physiological conditions before and after the modified procedure.

RESULTS

1) The median number of treatment sessions was 3.2, and 41 O-rings on average were required per individual patient. 2) The median nonrecurrence period after treatment was 18 months (Kaplan-Meier method). 3) Nine patients with a good response to modified EVL did not have recurrences for 16.9+/-2.8 months, and five with a poor response had recurrences at 5.8+/-2.2 months. Gastric varices were related to the response to modified EVL (p < 0.05, Mann-Whitney's U test). 4) Minor complications in modified EVL as well as standard EVL were experienced; however, we had a patient with the development of meningitis, which was a major septic complication. 5) Before modified EVL, EUS-CD demonstrated that good responders had undeveloped (grade I) gastric varices in five of nine (56%); however, poor responders had developed (grade III) gastric varices in four of five (80%) (p < 0.05, Mann-Whitney's U test]. 6) After modified EVL, EUS-CD revealed that six of nine (67%) good responders and one of five (20%) poor responders showed a decrease in color signals in supplying veins; however, none of the former (0%) and three of the latter (60%) showed an increase (p < 0.05, Mann-Whitney's U test].

CONCLUSION

Modified EVL was safe and effective, at least with regard to intermediate-term outcome, especially when treating patients with undeveloped gastric varices revealed by EUS-CD. Both good and poor responders showed no exacerbation of gastric varices after the modified procedure, ultrasonographically as well as endoscopically.

Influence of biliary drainage catheter on bile duct wall thickness as measured by intraductal ultrasonography

OBJECTIVE

To determine the influence of biliary drainage catheter placement on bile duct wall thickness, we performed intraductal ultrasonography (IDUS) in patients before and after biliary drainage.

METHODS

Patients underwent IDUS before and after either short-term (n = 9, 6 to 8 days) or long-term (n = 9, 14 to 35 days) biliary drainage using a thin (2.0 mm diameter), 20 MHz probe inserted by means of a transpapillary route or a percutaneous tract. The bile duct wall thickness (mean +/- standard deviation) was retrospectively measured at the upper portion of the common hepatic duct.

RESULTS

The bile duct wall thickness increased from 0.8+/-0.4 mm (predrainage) to 2.0+/-1.6 mm (post-drainage) in the long-term group (p < 0.001) but was not significantly increased in the short-term group.

CONCLUSIONS

The bile duct wall thickness as measured on IDUS appears to be increased after placement of biliary drainage catheters.

Chylous leakage after circumferential thoracolumbar fusion for correction of kyphosis resulting from fracture. Report of three cases

STUDY DESIGN

A description of the clinical picture of chylous leakage after spinal surgery.

OBJECTIVES

To present the clinical course of three cases of chylous leakage after spinal surgery and to discuss the pathogenesis of the disease.

SUMMARY OF BACKGROUND DATA

Chylous leakage is a rare complication after spinal surgery. It has been attributed to direct injury of a lymphatic trunk or one of its major tributaries by surgical maneuver.

METHODS

Three cases of chylous leakage after circumferential thoracolumbar fusion for correction of kyphosis resulting from fracture were reported.

RESULTS

All of the three cases were managed successfully; two cases of chyloretroperitoneum detected within 4 days after surgery were healed conservatively, but one case of chylothorax of which the onset was noticed 5 weeks after spinal surgery, required surgical ligation of the thoracic duct and pleurodesis.

CONCLUSION

Early detection of this disease is important for a good prognosis. Retroperitoneal drainage is necessary for the detection and management of chyloretroperitoneum. The pathogenesis and management of the chylous leakage are discussed in this report.

Limitations of intraductal ultrasonography in differentiating between bile duct cancer in stage T1 and stage T2: in-vitro and in-vivo studies

BACKGROUND AND STUDY AIMS

We investigated whether intraductal ultrasonography (IDUS) could distinguish between stage T1 and T2 bile duct cancer.

MATERIALS AND METHODS

In-vitro study. Resected bile duct specimens (n = 8) were immersed in a water tank and were pierced with straight pins to clarify the normal layer structure. Ultrasonosgraphic images (20MHz) of the positions of pin echoes were compared to the positions of pin holes as seen on histologic analysis of the specimens. In-vivo study. A thin-caliber high-frequency (6 Fr, 20 MHz) ultrasonic probe was inserted into the bile duct via a transhepatic route or a transpapillary route in 26 patients with bile duct cancer who underwent surgical resection.

RESULTS

In-vitro study. The inner hypoechoic layer on the IDUS image corresponded not only to the fibromuscular layer but also to a part of fibrous layer of the perimuscular loose connective tissue on histologic analysis, especially in the cases with moderate to severe bile duct wall fibrosis. The outer hyperechoic layer corresponded to the subserosal fat tissue. In-vivo study. In four of six patients with tumor limited to the inside hypoechoic layer on IDUS images, the histologic findings showed tumor invasion to the fibrous layer of the perimuscular loose connective tissue. Due to this limitation, accuracy of IDUS in T-staging was only 20/26 (77 %).

CONCLUSIONS

IDUS cannot reliably distinguish bile duct cancer in stage T1 from that in stage T2.

The value of LYM-1 cells for examining vacuole formation and loss of cell viability induced by culture supernates of Helicobacter pylori

Some strains of Helicobacter pylori are known to produce an extracellular cytotoxin that causes vacuolation in cultured mammalian cells. Screening for such strains makes use of HeLa cells which may not be sensitive enough to detect minimal changes. The aim of this study was to develop a more sensitive cell line. Vacuole formation was examined in HeLa cells, as well as four other cell lines established in this laboratory by ammonium chloride induction. Among five cell lines tested, LYM-1 cells were most sensitive for the detection of intracellular vacuolation with this agent. Loss of cell viability of LYM-1 and HeLa cells induced by H. pylori culture supernates was also examined: LYM-1 were more sensitive than HeLa cells. Cell death was not always accompanied by vacuole formation. This suggests that the mechanism whereby cell death occurs must be different from that for vacuole formation. LYM-1 cells may be useful when measuring vacuole formation and cell death of the cultured cells induced by culture supernates of clinical isolates of H. pylori.

The role of endoscopic balloon sphincteroplasty in patients with gallbladder and bile duct stones

We clarified the significance of endoscopic balloon sphincteroplasty (EBS) in the therapeutic treatment of biliary tract stones in the present era of laparoscopic cholecystectomy (LC). Patients with cholecysto-choledocholithiasis (n = 33) were treated by EBS. After endoscopic retrograde cholangiography (ERC), a balloon catheter (8 mm in diameter and 3 cm in width) was inserted into the bile duct using a guidewire, and positioned at the sphincter of Oddi. After inflating the balloon catheter, bile duct stones were removed by mechanical lithotripsy, a basket catheter, or a balloon catheter. In all patients, bile duct stones were removed by EBS without endoscopic sphincterotomy. No complication occurred except for 2 cases of mild pancreatitis, which was resolved within 48 hours. Twenty-four patients underwent LC before or after EBS. The remaining 9 patients did not undergo LC due to a poor-risk status for general anesthesia. None of them, however, experienced cholecystitis or colicky attacks after EBS. The combination of EBS and LC is an excellent method for treating cholecysto-choledocholithiasis.

Dependencies of motion assimilation and motion contrast on spatial properties of stimuli: spatial-frequency nonselective and selective interactions between local motion detectors

Two sets of experiments were carried out to examine dependencies of two types of induced motion (motion assimilation and motion contrast) on spatial properties of stimuli in terms of spatial-frequency tuning of local motion detectors. In the first set, the magnitudes of motion assimilation and motion contrast for a sinusoidal grating were measured at a function of the spatial frequency of the inducing gratings, with the spatial frequency of the test grating as a parameter. In the second set, the magnitudes were measured as a function of the height of the inducing gratings with the spatial frequencies of the test and the inducing gratings as parameters. For motion assimilation, the magnitude was characterized by a low-pass function of the spatial frequency of the inducing gratings, and the critical height of the inducing gratings, which demarcates the extent of the spatial pooling, varied systematically depending on the spatial frequency of the inducing gratings. For motion contrast, on the other hand, the magnitude was characterized by a hand-pass function, and the critical height depended on the frequency of the test grating. These results suggest that motion assimilation is mediated by the spatial-frequency nonselective interaction between the local detectors, in which the motion signals of the detectors tuned to different spatial frequencies are integrated with each other. Motion contrast is mediated by the spatial-frequency selective interaction, in which the motion signals of the local detectors tuned to the same or similar spatial frequencies are compared and differentiated.

The efficacy and safety of one-week triple therapy with lansoprazole, clarithromycin, and metronidazole for the treatment of Helicobacter pylori infection in Japanese patients

BACKGROUND

The aim of this study was to evaluate the efficacy and tolerability of 1-week, low-dose triple therapy with lansoprazole, clarithromycin, and metronidazole (LCM) for the cure of H. pylori infection and to establish the adequate dosage of a new triple therapy for Japanese patients.

MATERIALS AND METHODS

One hundred four H. pylori-positive Japanese patients were assigned alternatively to one of two groups: one to receive either 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily for 1 week (LCM1; n = 52); the other to receive 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 500 mg metronidazole twice daily for 1 week (LCM2; n = 52). H. pylori infection was assessed by smear, culture, and histological assessment (Giemsa stain) performed before and 4 weeks after cessation of the therapy.

RESULTS

The overall cure rates of H. pylori infection were 92.3% (48 of 52; 95% confidence interval (CI), 85% to 100%) in LCM1 and 92.3% (48 of 52; 95% CI, 85% to 100%) in LCM2. The cure rates in the patients without prior treatment were 95.7% (44 of 46; 95% CI, 89%-100%) in LCM1 and 95.7% (45 of 47; 95% CI, 89%-100%) in LCM2. Minor side effects were observed in 7.7% of LCM1 and 9.6% of LCM2, respectively.

CONCLUSION

The LCM1 regimen consisting of 30 mg lansoprazole once daily, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily (the regular doses in ordinary use in Japan) is a highly effective and safe regimen for Japanese patients. LCM1 as a new triple therapy is a promising regimen for the first-line treatment of H. pylori infection in Japanese patients.

Comparison of ranitidine and lansoprazole in short-term low-dose triple therapy for Helicobacter pylori infection

AIM

To evaluate the efficacy and safety of two 1-week low-dose triple-therapy drug regimens involving antisecretory drugs for Helicobacter pylori infection. 99 patients with H. pylori infection were treated with either lansoprazole or ranitidine used together with clarithromycin and metronidazole.

METHODS

The drug combination and administration periods in the proton pump inhibitor group were lansoprazole 30 mg o.m., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d., all given for 7 days (LCM group). The ranitidine group received ranitidine 150 mg b.d., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d. also for 7 days (RCM group). The presence or absence of H. pylori was determined from gastric biopsy specimens taken from both the antrum and the body, by smear, culture and tissue section (Giemsa stain). Cure was defined as failure to find evidence of H. pylori infection 4 weeks after antimicrobial therapy had ended.

RESULTS

The cure of H. pylori infection was 88% in the LCM group (44 of 50; 95% confidence interval (CI) = 79-97%) and 92% in the RCM group (45 of 49; 95% CI = 84-99%). The incidence of adverse events was 16% and 18% for the two groups, respectively.

CONCLUSIONS

No significant differences in cure rate and safety profiles were noted between the two regimens, suggesting that moderate acid inhibition using an H2-blocker is sufficient to achieve optimal H. pylori eradication.