[In vitro activities of faropenem against clarithromycin resistance Helicobacter pylori isolates]

Agar dilution and semi-solid agar dilution were used to determine the MIC of faropenem (FRPM) against 24 H. pylori isolates. FRPM was active against clarithromycin resistance H. pylori isolates. And, the MICs obtained by both methods were in agreement. The results suggest that FRPM was not affected by pH and is a clinically useful oral antibiotic for the eradication therapy of H. pylori infections.

Long-term sequelae of experimental gastritis with Helicobacter pylori: a 5-year follow-up study

To investigate the long-term effects of Helicobacter pylori gastritis on the gastric mucosa, 13 wild Japanese monkeys (six H. pylori-infected and seven controls) were monitored for 5 years. Colonization with H. pylori, the presence of macroscopic and histological gastritis, pyloric glandular height, and epithelial cell kinetics were investigated, using Ki-67 immunostaining in the gastric mucosa. In the infected group, persistent colonization with H. pylori was demonstrated by culture and histopathologic examination. In this group, the gastritis scores were significantly higher than in controls. Simultaneously, a significant decrease in the height of antral glands and a significant increase in the length of Ki-67-positive cells between the highest and lowest cells were also demonstrated in the infected animals. These experimental results directly demonstrate the effect of H. pylori infection on the gastric mucosa and may explain the potential mechanism for its causal role in the chain of events leading to gastric carcinoma.

Sequential analyses of the mutations in the core upstream and precore regions of hepatitis B virus genome in anti-HBe positive-carriers developing acute exacerbation

The nucleotide sequences of the core upstream and precore regions (371 nucleotide length, nt. 1604-1974) of hepatitis B virus (HBV) were analysed sequentially in three subjects who were positive serologically for anti-HBe and had acute clinical exacerbation after immunosuppressive treatment. These patients were asymptomatic HBV carriers before therapy. The results revealed that the mutant with an 8-bp deletion (nt. 1768-1775) located in the basic core promoter region was dominant in the asymptomatic HBV carrier phase in two of three subjects. After exacerbation, however, such mutant clones possessing 8-bp deletion disappeared or decreased in number and were replaced by the clones possessing a precore stop codon mutation G to A (nt. 1896) or by the clones possessing additional contiguous point mutations A to T (nt. 1762) and G to A (nt. 1764) and a new point mutation C to T (nt. 1653). Possible relationships between acute exacerbation of liver function accompanied by mutation and the transition of the dominant clones were discussed.

Sequential analyses of the mutations in the core upstream and precore regions of hepatitis B virus genome in anti-HBe positive-carriers developing acute exacerbation

The nucleotide sequences of the core upstream and precore regions (371 nucleotide length, nt. 1604-1974) of hepatitis B virus (HBV) were analysed sequentially in three subjects who were positive serologically for anti-HBe and had acute clinical exacerbation after immunosuppressive treatment. These patients were asymptomatic HBV carriers before therapy. The results revealed that the mutant with an 8-bp deletion (nt. 1768-1775) located in the basic core promoter region was dominant in the asymptomatic HBV carrier phase in two of three subjects. After exacerbation, however, such mutant clones possessing 8-bp deletion disappeared or decreased in number and were replaced by the clones possessing a precore stop codon mutation G to A (nt. 1896) or by the clones possessing additional contiguous point mutations A to T (nt. 1762) and G to A (nt. 1764) and a new point mutation C to T (nt. 1653). Possible relationships between acute exacerbation of liver function accompanied by mutation and the transition of the dominant clones were discussed.

Sensitive detection of Helicobacter pylori in gastric aspirates by polymerase chain reaction

The detection of Helicobacter pylori in gastric aspirate was examined by using the polymerase chain reaction (PCR) method for amplifying a specific fragment of the urease gene A. The ability of PCR to amplify H. pylori-specific DNA was analyzed by Southern hybridization with an internal oligonucleotide probe. Twenty-two H. pylori strains from clinical isolates and reference strains were studied, and all H. pylori strains yielded a 356-bp product that hybridized with the oligonucleotide probe, whereas no amplification was evident with 18 non-H. pylori strains. This could detect as little as 50 CFU of H. pylori in pure culture and 0.1 pg of purified chromosomal DNA. A total of 50 dyspeptic patients were examined for the presence of H. pylori by culture, the rapid urease test and histological examination of antral biopsy samples as well as by PCR in gastric juice aspirate samples. The gold standard for the presence of H. pylori was established by minimum concordance of two of three tests performed on biopsy specimens. With this gold standard, 34 of the 50 patients were considered to harbor H. pylori infection. PCR correctly identified 32 (94.1%) of these 34 infected patients. PCR had the best combination of sensitivity and specificity in assessing the correct diagnosis of H. pylori as compared with those of the rapid urease test and culture. Moreover, we established a fast and simple method for use by improvement of DNA extraction. PCR of the gastric aspirate was shown to be a sensitive and specific procedure which may be an attractive alternative to methods currently used for diagnosis of H. pylori infection.

p53 expression in gastric mucosa with Helicobacter pylori infection

Expression of p53 was examined immunohistochemically in the Japanese monkey model with Helicobacter pylori infection of the gastric mucosa to investigate the association between H. pylori infection and gastric carcinogenesis for a period of 4 years. In the course of these observations, from 3 years after H. pylori inoculation, nuclear staining for p53 was seen in the glandular cells of the mucosa infected with H. pylori, especially in the neck region of the glands. There was a gradual increase in the number of immunopositive cases among the infected animals. Three years after inoculation, three out of six cases, and 4 years after inoculation, four out of six cases exhibited positive staining for p53. Before inoculation, and up to 2 years after inoculation, the infected group showed no immunoreaction for p53. The non-infected group likewise displayed no immunostaining for p53 through 4 years of observation. These results suggest that p53 alterations occur in the H. pylori-infected gastric mucosa and that H. pylori infection may play an important role in gastric carcinogenesis.

Non-Hodgkin's lymphoma presenting with adrenal insufficiency and hypothyroidism: an autopsy case report

A 55-year-old male presented with an initial manifestation of primary adrenal insufficiency, hypothyroidism. Computed tomography scans showed enlarged bilateral adrenal glands and thyroid. A pathological diagnosis of diffuse large cell, B cell lymphoma was made by a needle biopsy of the adrenal gland. He was treated with combination chemotherapy and adrenal and thyroid hormone replacement. The lymphoma subsequently involved the central nervous system. He died of pneumonia 8 months after the presentation of the first symptom. The postmortem examination demonstrated a complete regression of lymphoma in the bilateral adrenal glands and thyroid. This is an extremely rare case of coexistent lymphoma of the adrenal glands and the thyroid presenting with adrenal failure and hypothyroidism.

Optical imaging of neural activity in auditory cortex induced by intracochlear electrical stimulation

Little is known about the representation of electrically evoked activity in the auditory cortex. We observed evoked activity in guinea pig auditory cortex evoked by acoustical and electrical stimulation to the cochlea by optical imaging with the aid of a voltage-sensitive dye. Light signals from the cortex were recorded with a 12 x 12 array of photodiodes, and transferred to the spatio-temporal images by every 0.57 ms. The activity by pure tones was shown spatio-temporally through tonotopical organization in the cortex according to the sound frequencies. The tonotopic responses were dynamically changed. When the cochlea was stimulated with single electrical pulses, focal activities were observed in the cortex as spatio-temporal patterns. Activated cortical regions were not sharply localized, but varied with stimulating positions of the cochlea. The curves of response magnitude versus stimulus intensity showed the narrow dynamic range, and that of latency was almost constant. These results were significantly different from those for normal sound stimulation.

Immunophenotyping of lymphocytes in the lung interstitium and expression of osteopontin and interleukin-2 mRNAs in two different murine models of pulmonary fibrosis

In the surfactant protein C/tumor necrosis factor (SP-C/TNF) transgenic mouse, the TNF-alpha transgene is overexpressed in type II pneumocytes. Pulmonary lymphocytic infiltration develops which is followed by fibrotic changes including accumulation of fibroblasts and deposition of extracellular matrix. We hypothesized that lymphocytes played a role in the development of pulmonary fibrosis in this model. Lymphocytes were recovered from the interstitium of the lung and analyzed by flow cytometry. The absolute number of lymphocytes recovered from transgenic mice were approximately four times of that in littermates. Flow cytometric analysis showed the presence of gamma delta T cells and B1 cells in the former group but these cells were almost absent in the lung of non-transgenic littermates. We also studied lymphocytes accumulating in the lung during bleomycin (BLM)-induced pneumopathy. Serial analyses showed a progressive increase of CD4/CD8 ratio after injection of BLM, reaching a peak at day 14, then decreased to the normal level by day 48. Northern blot analysis of the lung showed an enhanced expression of interleukin (IL)-2 and osteopontin (OPN) mRNA in those two models of pulmonary fibrosis. Expansion of clonal alpha beta T cells as detected by reverse transcriptase-polymerase chain reaction/single strand conformation polymorphism (RT-PCR/SSCP) suggests involvement of antigen-driven mechanisms in the development of pulmonary fibrosis.

Optical study of spatiotemporal inhibition evoked by two-tone sequences in the guinea pig auditory cortex

Spatiotemporal response patterns in the anterior and dorsocaudal fields of the guinea pig auditory cortex after two-tone sequences were studied in anesthetized animals (Nembutal 30 mg kg-1) using an optical recording method (voltage-sensitive dye RH795, 12 x 12 photodiode array). Each first (masker) and second (probe) tone was 30 ms long with a 10-ms rise-fall time. Masker-probe pair combinations of the same or different frequencies with probe delays of 30-150 ms were presented to the ear contralateral to the recording side. With same-frequency pairs, responses to the probe were inhibited completely after probe delays of less than 50 ms and the inhibition lasted for more than 150 ms, and the inhibition magnitudes in different isofrequency bands of the anterior field were essentially the same. With different-frequency (octave-separated) pairs, responses to the probe were not inhibited completely even after probe delays as short as 30 ms, and the inhibition lasted only for 110-130 ms. Inhibition magnitudes were different from location to location.

Real-time imaging of neural activity during binaural interaction in the guinea pig auditory cortex

Spatio-temporal patterns of binaural interaction in the guinea pig auditory cortex (AC) were observed using optical recording with a 12 x 12 photodiode array and a voltage-sensitive dye. The amplitudes of the sound-induced light signals from the cortex were transformed into sequential two-dimensional images every 0.58 ms. Binaural sound stimuli evoked an excitatory response followed by a strong inhibition, and contralateral stimuli evoked a strong excitatory response followed by a weak inhibition. Ipsilateral sound stimuli evoked a weak response. Binaural stimulation induced two types of ipsilateral inhibition: a fast binaural inhibition which was detected only after the contralateral and ipsilateral responses were subtracted from the binaural responses, and which appeared 12-25 ms after the onset of stimulation, and a slow binaural inhibitory effect which was clearly observed in the binaural responses themselves, appearing 70-95 ms after the onset of stimulation. The fast binaural inhibition was observed in the same area as the contralateral excitatory response. The inhibited area became stronger and more widespread with increasing intensity of ipsilateral stimulation. We did not observe the specialized organization of binaural neurons as electrophysiologically found in the cat AC, in which binaural neurons of the same binaural response type are clustered together and alternate with clusters of other response types.

Genotyping of hepatitis C virus in the Dominican Republic

Genotyping of hepatitis C virus (HCV) of liver disease patients in the Dominican Republic was performed. Eighty-four samples positive for HCV antibody, which were confirmed by ELISA, particle agglutination, and recombinant immunoblot assay III tests, were subjected to HCV genotyping by polymerase chain reaction using type-specific primers located in the nonstructural protein 5 region. Of the 84 samples tested, 50 (59%) were found to have genotype 1a/I and this genotype was the most frequent type detected in the present study. The numbers of isolates of genotypes 1b/II, 2a/III, 2b/IV, and 3a/V were three (3.6%) six (7.1%), two (2.4%), and two 2.4%), respectively. The number of samples having mixed genotype populations was 16 (19%). The possible causes of the high prevalence of genotype 1a/I in the Dominican Republic compared with other countries and of the high detection ratio of samples having mixed genotypes are discussed.

In vivo and in vitro effects of Sizofiran on the human neutrophils and the serum opsonic activity

In this paper, we examine the effects of SPG, which is a well known BRM, both in vivo and in vitro on the neutrophilic ROS production and the serum opsonic activity by the chemiluminescence technique using luminol as a probe. To investigate the in vivo effects, SPG was administered to 12 healthy male volunteers and two phases of enhancement of the neutrophilic ROS production and the serum opsonic activity was observed. In vitro, the addition of SPG showed a dose-dependent suppression. To investigate the mechanisms in these contradictory effects of SPG, supernatants of a lymphocytes culture medium in the presence of SPG with or without mitogen were added to the neutrophils. The addition of supernatants at a lower concentration of SPG (0.01 mg/ml) with mitogens showed significant preventive effects on the neutrophilic ROS production for the duration of incubation. This suggests that cytokines derived from lymphocytes may contribute to the in vivo effects of SPG. SPG can play an important role in the host's defense against microbe infections by enhancing it's effect on non-specific immunity when administered in vivo.

Optical imaging of dynamic horizontal spread of excitation in rat auditory cortex slices

Optical recordings using a voltage-sensitive dye (RH482) were conducted in brain slice preparations to investigate spatiotemporal patterns of excitation in the rat auditory cortex. Electrical stimulation of the border between the white matter and layer VI evoked vertical as well as horizontal spreading responses. While velocities of vertical and horizontal propagation of excitation were similar to those reported in non-disinhibited preparations, the horizontal propagation was widespread and strong especially in layers II/III in auditory cortex slices. This horizontal spread was blocked by 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) but not by D-2-amino-5-phosphonopentanoic acid (D-AP5). These results suggest that the horizontal responses, especially in layers II/III, are prominent and are mediated primarily by non-N-methyl-D-aspartic acid (NMDA) receptors in the auditory cortex.

A new semi-solid agar dilution method for determining amoxycillin, clarithromycin and azithromycin MICs for Helicobacter pylori isolates

The MICs of amoxycillin, clarithromycin and azithromycin for 26 strains of Helicobacter pylori were determined using Mueller-Hinton semi-solid agar (SSA) without CO2 incubation, as in the conventional agar dilution method. The tested H. pylori strains grew satisfactorily in the SSA method within 48 h of incubation. Reasonable values of MICs of three antibiotics for these strains were obtained by this method, avoiding the inactivation of macrolides due to acidification of the medium. By this method, the MICs of the antibiotics for the reference strains were within the acceptable NCCLS ranges for quality control.

Clinical usefulness of the effective regurgitant orifice area determined by transesophageal echocardiography in patients with eccentric aortic regurgitation

BACKGROUND AND AIMS OF THE STUDY

The aortic regurgitant jet is frequently eccentric, and Doppler color flow mapping techniques of the distal jet is influenced by this eccentricity. The aim of the present study was to determine whether the effective regurgitant orifice area (EROA), determined by the proximal isovelocity surface area (PISA) method using multiplane transesophageal echocardiography (m-TEE), could be used to evaluate the severity of aortic regurgitation (AR) in patients with an eccentric jet.

METHODS

Forty-eight patients with eccentric AR were studied. Values of EROA determined by the PISA method were compared with results from cross-sectional area (CSA), vena contracta (VC) width, aortic angiography, and regurgitant fraction.

RESULTS

Values of EROA correlated well with results from CSA (r = 0.73, p < 0.001), VC (r = 0.74, p < 0.001), angiographic grade (rs = 0.90 p < 0.001), and regurgitant fraction (r = 0.84, p < 0.001) in patients with eccentric aortic regurgitation. Values of EROA > 0.27 cm2 were always associated with a regurgitant fraction > 0.4, while EROA values < 0.27 cm2 were always associated with a regurgitant fraction < 0.4.

CONCLUSIONS

We conclude that, in patients with an eccentric jet, measurement of EROA values by the PISA method using m-TEE is a reliable method of assessing the severity of AR.

Hepatoid carcinoma of the lung with production of alpha-fetoprotein and abnormal prothrombin: an autopsy case report

Alpha-fetoprotein (AFP) is a useful tumor marker for the diagnosis of hepatic and testicular tumors. Several cases of AFP-producing lung cancer have been reported. We present here a patient with AFP-producing primary lung carcinoma, which showed high values of serum AFP (100,000 ng/mL). The concanavalin A nonbinding fraction rate of AFP was 15%. Gross and microscopic features of the lung carcinoma bore a striking resemblance to those of hepatocellular carcinoma. According to the histologic classification of lung tumor, this case was large cell carcinoma with prominent hepatoid differentiation. Immunohistochemically, we detected AFP in the cytoplasm of the neoplastic cells. We also detected another useful tumor marker for the diagnosis of hepatocellular carcinoma, i.e., des-gamma-carboxy prothrombin (protein induced by vitamin K absence or the absence of antagonist-II [PIVKA-II]), in serum using an enzyme immunoassay and in tumor cells by immunohistochemical analysis.

Virulence-associated genes as markers of strain diversity in Helicobacter pylori infection

To establish a marker of strain diversity of Helicobacter pylori, a genetic examination was performed based on the detection rates by PCR of cagA and vacA, which are known to be virulence-associated genes. The test strains were obtained from 70 patients suffering from gastric ulcer (GU), 82 patients with duodenal ulcer (DU) and 48 patients with gastritis (GS). Fragments located in the three different regions of vacA were amplified; V1 being the upstream portion, V2 the mid-portion and V3 the downstream portion. For cagA, the detection rates were 70% for GU, 79% for DU and 50% for GS, showing a significantly higher rate for DU than for GS (P = 0.0005). With V1, the detection rates were 90% for GU, 90% for DU and 69% for GS, giving a significantly higher rate for GU than for GS (P = 0.0036) and also giving a significantly higher rate for DU than for GS (P = 0.0019). With V2, the detection rates were 60% for GU, 70% for DU and 44% for GS, giving a significantly higher rate for DU than for GS (P = 0.0024). The differences in vacA gene polymorphism were closely related to the evidence of gastroduodenal ulcers in H. pylori infection. Furthermore, the detection rates of cagA and polymorphisms of vacA by PCR could be used as markers of strain diversity in H. pylori-induced gastroduodenal ulcer.

[The case of left atrial myxoma originating from posterior leaflet of mitral valve]

We experienced the case of left atrial myxoma originating from posterior leaflet mitral valve. Mitral valve repair was performed in that case, because of the presence mitral leaflet defect due to removal of the myxoma. Transesophageal echocardiography was a useful tool for perioperative evaluation of the mitral valve and precise localization of the origin of the myxoma.

[Diffuse alveolar hemorrhage associated with idiopathic interstitial pneumonia syndrome after allogeneic bone marrow transplantation]

A 24-year-old male with myelodysplastic syndrome (refractory anemia) was treated with allogeneic bone marrow transplantation (BMT) from HLA-identical brother on September 9, 1994, after conditioning with busulfan and cyclophosphamide. From early in April 1995, the patient complained of cough and fever. Chest X-ray showed interstitial infiltrates involving hilar and lower lung fields. Although pulmonary infiltrates were resolved with methylprednisolone pulse therapy, on May 19, the patient rapidly deteriorated with dyspnea. Diffuse alveolar infiltrates appeared on chest X-ray and he died of respiratory failure. At autopsy, diffuse alveolar hemorrhage accompanied with thickening of the alveolar walls and interstitial infiltration of lymphocytes was demonstrated. There was no evidence of bleeding in other organs. This is a rare case of diffuse alveolar hemorrhage in the late stage of allogeneic BMT. This report should lead to an evaluation of this disease by the collection of similar cases.

Insulin-like growth factor-I mediates osteoclast-like cell formation stimulated by parathyroid hormone

There have been several lines of evidence that parathyroid hormone (PTH) stimulates production of insulinlike growth factor I (IGF-I) in bone and that IGF-I stimulates osteoclast formation. Thus, the present study was performed to clarify the possible role of IGF-I in PTH-stimulated osteoclastlike cell formation and the role of PTH-responsive dual signal transduction systems (cyclic [c] AMP-dependent protein kinase [PKA] and calcium/protein kinase C [PKC]) in its mechanism. Treatment with anti-IGF-I antibody (1-10 micrograms/ml) partially but significantly blocked hPTH-(1-34)-stimulated osteoclastlike cell formation in unfractionated mouse bone cell cultures, although it did not affect osteoclastlike cell formation stimulated by 1,25-dihydroxyvitamin D3. Rp-cAMP5 (10(-4) M), a direct PKA inhibitor, as well as two types of PKC inhibitors, H-7 (10 microM) and staurosporine (3 nM), and dantrolene (10(-5) M), an inhibitor of calcium mobilization from intracellular calcium stores, all significantly blocked PTH-stimulated osteoclastlike cell formation. Anti-IGF-I antibody (3 micrograms/ml) significantly blocked osteoclastlike cell formation stimulated by 10(-4) M dbcAMP, 10(-4) M Sp-cAMPS, a direct PKA activator, and 10(-5) M forskolin in mouse bone cell cultures. Dibutyryl cAMP, forskolin, and hPTH-(1-34) significantly stimulated mRNA expression of both IGF-I and IGF-binding protein 5 (IGFBP-5) in these cultures, but neither 10(-7) M PMA, a PKC activator, nor 10(-7) M A23187 did. Moreover, anti-IGF-I antibody significantly blocked osteoclastlike cell formation stimulated by the conditioned medium from MC3T3-E1 cells pretreated with 10(-8) PTH-(1-34), which induced IGF-I and IGFBP-5 mRNA expression in these cells. In conclusion, the present study indicates that IGF-I mediates osteoclastlike cell formation stimulated by PTH and that the PKA pathway is involved in its mechanism. However, IGF-I does not seem to be the sole effector molecule to be active in this system.

Stimulatory effects of parathyroid hormone and 1,25-dihydroxyvitamin D3 on insulin-like growth factor-binding protein-5 mRNA expression in osteoblastic UMR-106 cells: the difference between transient and continuous treatments

The transient treatment with parathyroid hormone (PTH) for 12 h, followed by its removal for 36 h, stimulated insulin-like growth factor-binding protein (IGFBP)-5 mRNA expression more strongly than the continuous treatment for 48 h in osteoblastic UMR-106 cells. The transient but not continuous treatment with A23187 also stimulated it. In contrast, 1,25-dihydroxyvitamin D3 stimulated it, irrespective of the treatment design. IGFBP-5 stimulated type-1 procollagen mRNA expression. The present study first indicated that the transient treatment with PTH more effectively stimulated IGFBP-5 mRNA expression than its continuous treatment partly via an increase in intracellular calcium and suggested that IGFBP-5 might be involved in the anabolic action of PTH in bone.

Effect of natural menopause on serum levels of IGF-I and IGF-binding proteins: relationship with bone mineral density and lipid metabolism in perimenopausal women

The present study was performed to examine the effect of natural menopause on serum levels of IGF-I, IGF-binding protein (IGFBP)-2 and -3 as well as on bone mass and lipid metabolism in perimenopausal women. One hundred and twenty-one healthy Japanese women, who were 45-55 years old, were studied (71 premenopausal and 50 postmenopausal women 1-9 years after menopause). Bone mineral density (BMD) was measured at the middle third of the radius by using dual energy X-ray absorptiometry. Serum levels of IGF-I, but not those of IGFBP-2 or -3, were significantly reduced in the postmenopausal group compared with the premenopausal group. One year after menopause, serum IGF-I levels were significantly lower, and the biochemical markers of bone turnover, such as serum total alkaline phosphatase level and urinary calcium to creatinine ratio, were significantly higher than the premenopausal levels. Serum levels of IGF-I, but not those of IGFBP-2 or -3, were positively correlated with BMD. Serum levels of IGFBP-2, but not those of IGF-I or IGFBP-3, were negatively correlated with body mass index and body weight. Finally, serum levels of IGFBP-3, but not those of IGF-I, were positively correlated with serum levels of total cholesterol and triglyceride. The present findings suggest that a rapid decrease in serum IGF-I levels after menopause might be partly involved in bone loss following gonadal failure and that IGFBP-2 and -3 might be related to the regulation of body mass and lipid metabolism during perimenopause respectively, although the mechanisms remain unknown.

Hemolytic uremic syndrome following autologous peripheral blood stem cell transplantation in a patient with malignant lymphoma

Hemolytic uremic syndrome (HUS) has been reported in patients receiving bone marrow transplantation. However, only a few cases of HUS following autologous peripheral blood stem cell transplantation (PBSCT) have been reported. We present a case of HUS developing after autologous PBSCT in a 40-year-old man with non-Hodgkin's lymphoma. It appears that the chemotherapeutic agents administered during the conditioning regimen for PBSCT may have played an important role in the development of HUS in our patient. In the present case, the combination therapy of vincristine, methylprednisolone, and ticlopidine hydrochloride was effective.

Effect of pravastatin (10 mg/day) on progression of coronary atherosclerosis in patients with serum total cholesterol levels from 160 to 220 mg/dl and angiographically documented coronary artery disease. Coronary Artery Regression Study (CARS) Group

To evaluate the effect of pravastatin on progression of coronary atherosclerosis in normocholesterolemic patients with coronary artery disease (CAD), 90 patients with CAD and serum cholesterol levels of 160 to 220 mg/dl were randomized into a pravastatin (10 mg/day) group (n = 45) and control group (n = 45) in a 2-year study. The proportions of patients with progression (an increase of > or = 15% in percent stenosis) and regression (a decrease of > or = 15% in percent stenosis) of coronary atherosclerosis were compared between the 2 groups. Of 90 patients, 80 (89%) had a final angiogram: the pravastatin (n = 39) and control group (n = 41). Percent changes in total cholesterol, low-density lipoprotein cholesterol, and apoprotein B levels were significantly greater in the pravastatin group than in the control group (total cholesterol -11 +/- 12% vs 3 +/- 15%, p < 0.01; low-density lipoprotein cholesterol -18 +/- 16% vs 4 +/- 21%, p < 0.01; apoprotein B -5 +/- 20% vs 6 +/- 20%, p < 0.05). The proportion of patients with progression of coronary atherosclerosis was significantly smaller in the pravastatin group than in the control group (21% vs 49%, p < 0.05). The proportion of patients with disease regression did not differ in the 2 groups (3% vs 2%, p = NS). In conclusion, this study indicates that cholesterol-lowering therapy with pravastatin can prevent the progression of coronary atherosclerosis even in normocholesterolemic patients with established CAD.

Helicobacter pylori infection accelerates human gastric mucosal cell proliferation

Helicobacter pylori causes chronic atrophic gastritis and intestinal type gastric cancer arises against a background of atrophic gastritis. Increased proliferation of epithelial cells is an important indicator of increased risk for gastric adenocarcinoma. We investigated gastric mucosal cell proliferation in H. pylori-associated gastritis and the effect of eradication therapy on this proliferation in 45 patients endoscopically diagnosed (31 with persistent eradication and 14 in whom H. pylori) recurred. H. pylori status was determined by culture and histology in biopsied specimens from the gastric antrum and corpus. Eradication of the infection was defined as reversal to negative on both tests. In vitro Ki-67 immunostaining of endoscopic biopsy specimens was used to measure mucosal cell proliferation in H. pylori-associated gastritis before and after therapy. The proliferative zone was defined as the distance of Ki-67-positive gastric epithelial cells between the highest and the lowest cells. In patients in whom H. pylori was eradicated, cell proliferation in both the antral and corpus mucosa had decreased 4 weeks after completion of the eradication therapy (P < 0.01, P < 0.001), and 6 months later, it had markedly decreased (P < 0.05, P < 0.05) and returned to normal. In patients in whom H. pylori recurred, only antral epithelial cell proliferation was reduced 4 weeks after eradication therapy, but when H. pylori recurred, determined by culture and histology, cell proliferation level was the same as that before eradication. These results suggest that H. pylori infection accelerates cell proliferation in gastric mucosa and may play a causal role in the chain of events leading to gastric carcinoma.

Significance of negative U waves in the precordial leads during anterior wall acute myocardial infarction

This study was conducted to clarify the clinical significance of negative U waves in the precordial leads during anterior wall acute myocardial infarction (AMI). In all, 141 patients with first anterior wall AMI (< or = 6 hours) were classified into 2 groups according to the presence (group A, n = 31) or absence (group B, n = 110) of negative U waves in the precordial leads on the admission electrocardiogram (ECG). The number of leads showing ST elevation > or = 1 mm on the admission ECG was smaller in group A than in group B (5.2 +/- 1.3 vs 6.2 +/- 1.7, p < 0.01). Emergent coronary arteriography revealed that group A had a higher incidence of good collateral circulation than group B (39% vs 19%, p < 0.05). Peak creatine kinase activity was lower in group A than in group B (1,708 +/- 1,271 vs 2,735 +/- 1,865 IU/L, p < 0.01). The number of abnormal Q waves on the predischarge ECG was smaller in group A (2.0 +/- 1.5 vs 3.4 +/- 2.0, p < 0.01). Group A had a greater left ventricular ejection fraction and better regional wall motion in the anterobasal, anterolateral, and apical regions in the chronic phase than group B. In conclusion, patients with anterior wall AMI having negative U waves in the precordial leads on admission had a relatively smaller mass of necrotic myocardium than those without the waves. Therefore, negative U waves during anterior wall AMI may be a useful marker for identifying patients with smaller infarction partly due to better collateral circulation.

[Direct in situ PCR method for the detection of verotoxin-producing Escherichia coli]

Rapid detection of verotoxin-producing Escherichia coli at a single-cell level under an epifluorescence microscope without culturing processes was accomplished by using the direct in situ PCR technique. We used a DNA primer set for amplification of the slt-I and slt-II genes encoding respectively verotoxin 1 and 2 (EVT and EVS primers). The bacterial cells were detected specifically by the HNPP (2-hydroxy-3-naphthoic acid-2'-phenylanilide phosphate)/Fast Red TR reaction technique. The direct in situ PCR with HNPP/Fast Red TR technique is applicable to the detection of verotoxin-producing bacteria with the slt-I or slt-II gene in not only Escherichia coli O157 but also VTEC of other serotypes.

[Detection of Aspergillus species DNA in serum samples of the patients with non-invasive pulmonary aspergillosis]

We investigated the possible presence of Aspergillus species DNA in serum samples of two patients diagnosed as having non-invasive pulmonary aspergillosis by a nested polymerase chain reaction (PCR) method. The nested PCR results were negative in serum samples of the patients with chronic necrotizing pulmonary aspergillosis and pulmonary aspergilloma. When left pneumothorax happened to the patient with chronic necrotizing pulmonary aspergillosis and bronchial washing was performed to the patient with pulmonary aspergilloma, the nested PCR results turned positive. We consider this method useful for the diagnosis of semi-invasive stage of pulmonary aspergillosis. However, further prospective evaluation with a large clinical sample is required.

[A pathological study of cytomegalovirus infections in autopsied cases with adult T-cell leukemia]

In this study, cytomegalovirus (CMV) infection was found in eleven of 21 autopsied cases (52.4%) with adult T-cell leukemia (ATL). Seven cases (63.6%) revealed disseminated infection in more than three organs. The lungs were involved in all eleven cases (100%), adrenal glands in eight cases (72.7%), esophagus in four cases (36.4%), and stomach, small intestine and urinary bladder in three cases (27.3%). Histopathological findings suggested that lung involvement was the cause of death in five of the 11 cases, the small intestine were involved in two of the 3 cases, and the adrenal glands were involved in one of the 8 cases. In summary, CMV infection was found to be the main cause of death in five (45.5%) of the 11 ATL patients.

Serial evaluation of atrial function by Doppler echocardiography after the maze procedure for chronic atrial fibrillation

The primary goal of the maze procedure is to prevent thromboembolism by restoring atrial function. We used Doppler echocardiography to evaluate the atrial function of patients who had undergone the maze procedure for the treatment of chronic atrial fibrillation. Thirty-five patients who converted to sinus rhythm after the maze procedure were enrolled in this study. Doppler echocardiography was performed in all patients in the early (mean, 19 days) and late (mean, 245 days) phases of the postoperative period. Left and right atrial active contraction fractions and left and right atrial storage fractions were calculated. The relationship between the pre-operative left atrial dimension and the left atrial active contraction fraction was evaluated in the late postoperative phase. The left atrial active contraction fraction was significantly increased in the late phase, but there was no change in the left atrial storage fraction. While the right atrial storage fraction was improved in the late phase, the right atrial active contraction fraction was increased even in the early phase. In patients with non-rheumatic mitral valve disease, a significant negative correlation was observed between the pre-operative left atrial dimension and the left atrial active contraction fraction in the late postoperative phase (r = 0.61; P < 0.05). However, no correlation between these parameters was observed in patients with rheumatic mitral valve disease. Atrial function was improved after the maze procedure. Serial difference were observed between left and right atrial function during recovery. Thus, in patients with non-rheumatic mitral valve disease, the left atrial dimension prior to the maze procedure may be useful in predicting the atrial contractile function postoperatively.

Can the maze procedure be combined safely with mitral valve repair?

BACKGROUND AND AIMS OF THE STUDY

The safety of combining mitral valve repair with the maze procedure for chronic atrial fibrillation in the surgical management of patients with mitral valve disease is not well elucidated. We present our operative results regarding mortality and morbidity after such combined surgery. As a comparison, our operative results after mitral valve repair in patients without chronic atrial fibrillation are presented.

METHODS

Between April 1993 and December 1994, 39 patients with chronic atrial fibrillation underwent mitral valve repair and concomitant maze procedure (group 1) at the Iwate Medical University. During the same period, 36 patients with sinus rhythm and one patient with DDD pacemaker underwent mitral valve repair (group 2). In order to evaluate the operative risk, morbidity, and mortality of adding the maze procedure to mitral valve repair, total cardiopulmonary bypass time, aortic cross-clamp time, intraoperative blood loss, intubation period, and duration of ICU stay were compared between the groups.

RESULTS

Total cardiopulmonary bypass time and aortic cross-clamp time in group 1 were longer than in group 2 (174.0 +/- 38.8 min versus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus 95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU stay, intubation period, and intraoperative blood loss were not different between the groups. There were no hospital deaths in either group. Four patients in group 1, and two patients in group 2 required re-exploration for bleeding (p = NS). Two patients in group 1, and none in group 2 required pacemaker implantation postoperatively (p = NS). Two patients in group 2, and none in group 2 had minor cerebral infarction (p = NS). At hospital discharge, 28 patients in group 1 (72%) and 35 patients (97%) in group 2 were in sinus rhythm.

CONCLUSIONS

The maze procedure can be combined with mitral valve repair without adding undue operative risk to patients. Those patients with chronic atrial fibrillation undergoing mitral valve repair may be advised for the possibility of concomitant maze procedure.

Behçet's disease associated with myelodysplastic syndromes. A case report and a review of the literature

BACKGROUND

Behçet's disease has rarely been reported in association with myelodysplastic syndromes (MDS). Increased production of reactive oxygen species (ROS) by neutrophils has a primary role in the pathogenesis of Behçet's disease. However, decreased production of ROS by neutrophils has frequently been reported in patients with MDS. The current study was undertaken to determine the role of ROS production in a patient with Behçet's disease and MDS.

METHODS

A patient with MDS with trisomy 8 who developed Behçet's disease is described and a review of the literature of patients with Behçet's disease in MDS is presented. The production of ROS by neutrophils was investigated by luminol-enhanced chemiluminescence (CL) assay.

RESULTS

Based on a review of the literature, 10 cases of Behçet's disease associated with MDS have been reported to date. Nine patients had undergone cytogenetic analysis of bone marrow cells, 7 of whom (78%) had trisomy 8. Neutrophils taken from the authors' patient during the active phase of Behçet's disease demonstrated an increased CL response. Moreover, serum from this patient increased the CL emission of neutrophils from healthy volunteers.

CONCLUSIONS

These data suggest that trisomy 8 predisposes to Behçet's disease in patients with MDS. Furthermore, an increased ROS production by neutrophils may be associated with the diverse clinical findings in this disease. In this study, neutrophils were activated directly by serum factors.

Effect of antimicrobial agents on the piliation of Pseudomonas aeruginosa and adherence to mouse tracheal epithelium

The effect of subminimal inhibitory concentrations (sub-MICs) of antimicrobial agents on the adherence of Pseudomonas aeruginosa (pili+) to trachea mucosal cells, the first stage in the development of P. aeruginosa respiratory tract infections, was investigated. The adherence of P. aeruginosa to the cells of the lower respiratory tract using a model of acid-injured trachea in mice was observed by electron microscopy (transmission and scanning). When P. aeruginosa was cultured with 1/4 MIC of erythromycin, minocycline, clindamycin, ofloxacin or tobramycin at 37 degrees C for 4 hours, the number of pili was significantly reduced (P < 0.01), together with a significant reduction in the number of adherent bacteria at 1/4 MIC of erythromycin (P < 0.01). No suppressive effects of piperacillin or ceftazidime were obtained on the piliation and adhesion of P. aeruginosa. These findings indicate that sub-MICs of erythromycin reduce the adherence of P. aeruginosa to the tracheal mucosa, which may prevent the onset of P. aeruginosa respiratory tract infection.

Behçet's disease associated with myelodysplastic syndromes. A case report and a review of the literature

BACKGROUND

Behçet's disease has rarely been reported in association with myelodysplastic syndromes (MDS). Increased production of reactive oxygen species (ROS) by neutrophils has a primary role in the pathogenesis of Behçet's disease. However, decreased production of ROS by neutrophils has frequently been reported in patients with MDS. The current study was undertaken to determine the role of ROS production in a patient with Behçet's disease and MDS.

METHODS

A patient with MDS with trisomy 8 who developed Behçet's disease is described and a review of the literature of patients with Behçet's disease in MDS is presented. The production of ROS by neutrophils was investigated by luminol-enhanced chemiluminescence (CL) assay.

RESULTS

Based on a review of the literature, 10 cases of Behçet's disease associated with MDS have been reported to date. Nine patients had undergone cytogenetic analysis of bone marrow cells, 7 of whom (78%) had trisomy 8. Neutrophils taken from the authors' patient during the active phase of Behçet's disease demonstrated an increased CL response. Moreover, serum from this patient increased the CL emission of neutrophils from healthy volunteers.

CONCLUSIONS

These data suggest that trisomy 8 predisposes to Behçet's disease in patients with MDS. Furthermore, an increased ROS production by neutrophils may be associated with the diverse clinical findings in this disease. In this study, neutrophils were activated directly by serum factors.

Electrocardiographic nature of restored sinus rhythm after Cox maze procedure in patients with chronic atrial fibrillation who also had other cardiac surgery

OBJECTIVE

To characterise heart rate variability and high frequency components of restored sinus rhythm after the maze procedure. The maze procedure for chronic atrial fibrillation may prevent thrombotic events and improve the quality of life. However, the electrocardiographic nature of restored sinus rhythm after the maze procedure has not been fully elucidated.

PATIENTS AND METHODS

Between March 1993 and August 1995, 104 consecutive patients undergoing the maze procedure in combination with other cardiac surgery were studied. There were 100 long-term survivors (78 with mitral valve disease, 9 with aortic valve disease, 8 with congenital heart disease, and 5 others). Twenty age-matched patients with mitral valve disease who were in normal sinus rhythm preoperatively were enrolled as a control group. 30 days after surgery, the presence of arrhythmias and the circadian changes of heart rate variability were estimated by ambulatory electrocardiographic monitoring and the filtered P duration was evaluated by signal-averaged electrocardiogram.

RESULTS

Restoration of sinus rhythm was observed in 73 of 100 cases. Subjects were classified into three groups according to their postoperative ambulatory electro-cardiographic monitoring findings: patients in group 1 (n = 73) (1a: 58 regular sinus rhythm; 1b: 15 sinus rhythm with frequent premature atrial contractions (> 1000/day); patients in group 2 (n = 21) still had persistent atrial fibrillation; and patients in group 3 (n = 6) required permanent pacemaker implantation because of sick sinus syndrome. The success rate of restoration of sinus rhythm was 88.3% if left atrial diameter was small (< 65 mm). Circadian changes in the low frequency to high frequency power ratio in group 1a were significantly diminished compared with control group (P < 0.01). Furthermore, the filtered P duration in group 1a (150 (20) ms) and group 1b (158 (23) ms) were longer than in the control group (122 (11) ms) (P < 0.01).

CONCLUSIONS

The maze procedure may result in a decreased sinus response and non-uniform transmission of impulses in the atrium.

[Immunodeficiency and carcinogenesis in patients with chronic active Epstein-Barr virus infection]

Three adult patients with chronic active Epstein-Barr virus infection (CAEBV) had high anti-EBV-VCA antibody, positive anti-EA, low anti-EBNA and were associated with systemic lymphadenopathies and immunosuppression. The case 1 and 2 had elevated serum immunoglobulin levels, and recurrent infections, and case 3 showed pancytopenia. These 3 cases developed both EBV and latent membrane protein (LMP) positive malignant histiocytosis, EBV positive but LMP negative plasmacytoma, and EBV negative acute myelogeneous leukemia, respectively. It was suggested that CAEBV belonged to high risk groups for the development of malignant neoplasms. Since HLA of the case 1 and his father was identical, we conducted a in vitro cytotoxicity test using EBV transformed autologous B lymphocytes, K562 cells, and Raji cells to clarify the association of immunosuppression and HLA. The case 1 showed a low level of specific cytotoxicity to autologous EBV transformed B cells, while his parents were negative for the specific cytotoxicity. The patient and his parents developed inducible cytotoxicity to all targets after in vitro incubation of peripheral mononuclear cells with recombinant interleukin 2 (rIL-2) for 7 days. The patient and his mother showed lower enhancement of cytotoxicity, while HLA identical father could induce good cytotoxic activity to all targets as well as normal controls, indicating that a low IL-2 induced cytotoxic activity observed in CAEBV was independent of HLA associated immunoregulation at least in the case 1. Further studies are required to clarify the exact mechanisms responsible for the development of CAEBV.

Optical imaging of spatiotemporal patterns of glutamatergic excitation and GABAergic inhibition in the guinea-pig auditory cortex in vivo

1. Glutamatergic excitation and gamma-aminobutyric acid (GABA)-ergic inhibition in layers II and III of the auditory cortex of anaesthetized guinea-pigs were recorded optically using a voltage-sensitive dye RH795 and a 12 x 12 photodiode array. 2. After contralateral ear stimulation with pure tones, transient excitatory responses followed by inhibitory responses were observed in fields A (primary) and DC of the auditory cortex. The area of the excitatory responses was sandwiched or surrounded by the areas of the inhibitory responses. 3. Optically recorded excitatory responses to pure tones had two components: a component sensitive to 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), a non-N-methyl-D-aspartate (non-NMDA) receptor antagonist, and a component sensitive to 2-amino-5-phosphono-valerate (APV), an NMDA receptor antagonist. Application of CNQX (5 microM) to the auditory cortex suppressed an early, but not a late, phase of the excitation; application of APV (100 microM) had the opposite effect. Concomitant application of CNQX and bicuculline methiodide (BMI, 4 microM), a GABAA receptor antagonist, increased the amplitude of the late phase 4-fold. This enhanced response was suppressed by APV. 4. These results indicate that (i) auditory cortical excitatory responses are mediated by both non-NMDA and NMDA receptors, (ii) inhibition is mediated by GABAA receptors, (ii) the excitatory bands are sandwiched or surrounded by GABAA receptor-mediated inhibitory areas and (iv) GABAA receptors effectively inhibit the NMDA, but not the non-NMDA, receptor-mediated excitation.

[Detection of DNA specific for Aspergillus species in serum samples from two patients with invasive pulmonary aspergillosis]

We investigated the possible presence of DNA specific for Aspergillus species in serum samples of two patients who were strongly suspected for invasive pulmonary aspergillosis (IPA) by a nested polymerase chain reaction (PCR) method. Both patients were diagnosed as having acute myelogenous leukemia and treated with induction chemotherapy. During chemotherapy-induced granulocytopenia, they complained of high fever, and the chest X-rays indicated infiltration shadows in their lungs. They were treated with antibiotics intravenously, but no clinical improvement was observed. As the results of the nested PCR were positive at the acute stage of infection, amphotericin B i.v. and granulocyte colony stimulating factor s.c. administrations were started in both cases. In case 1, the infectious disease improved and the nested PCR results turned negative after treatment. In case 2, in spite of the progression of the disease, the nested PCR results turned negative during treatment. Although we consider this method very useful for the diagnosis of IPA, further prospective evaluation with a large clinical population sample is required.

In vitro susceptibility of Trichosporon beigelii to antifungal agents

The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of amphotericin B, flucytosine, miconazole, fluconazole and itraconazole against 21 isolates of Trichosporon beigelii in RPMI-1640 medium were determined using National Committee for Clinical Laboratory Standards (NCCLS) methodology in microdilution method. Most isolates were sensitive to miconazole (MIC90 0.78 microgram/ml), fluconazole (MIC90 6.25 micrograms/ml), and itraconazole (MIC90 0.19 microgram/ml), with the former being the most active agent tested (MFC90 3.12 mu/ml). Although amphotericin B inhibited most strains (MIC range, 0.78-3.12 micrograms/ml), poor fungicidal activity was observed (MFC range, 1.56-12.5 micrograms/ml) showing a pattern of relative resistance in vitro. Flucytosine showed generally poor activity against most isolates tested. These in vitro findings confirm the resistance of T.beigelii to amphotericin B and suggest that azoles may be an alternative to the former for the treatment of disseminated trichosporonosis. However, in vivo studies would better validate these in vitro findings.

Atopic dermatitis successfully treated by eradication of Helicobacter pylori

A relationship between allergic diseases and Helicobacter pylori infection has recently been noted. We report a case of atopic dermatitis and H. pylori infection in a 14-year-old girl. She had had widespread diffuse skin erythema with erosions and pigmentation since the age of 3 years. Endoscopically, there was chronic antral gastritis with H. pylori infection and histological eosinophilic infiltration. A high titer of H. pylori-specific IgG was present in serum. She was treated with a proton pump inhibitor (lansoprazole 60 mg), an antibiotic (clarithromycin 800 mg), and plaunotol (a mucosal protective agent, 480 mg) for 2 weeks to eliminate the infection. After 10 days of treatment, erythema and itching were more widespread and vesicle formation was seen on the foot. Generalized skin lesions abated a few days later. After eradication of the bacterium by the treatment, eosinophils decreased from 38.8% to 19.0%, and the clinical signs of atopic dermatitis almost disappeared. Serum gastrin level and the pepsinogen I/II ratio were normalized and histological findings of gastric mucosa showed improvement. H. pylori-specific IgE antibody, analyzed by the Western blot method, gradually decreased with the eradication treatment.

Sofalcone for treatment of Helicobacter pylori infection

It is difficult to regard sofalcone as a single drug for the treatment of Helicobacter pylori infection. However, sofalcone exerts multiple effects against H. pylori: it has antibacterial activity, induces morphological changes, inhibits adhesion to gastric mucin and inhibits lipolytic activity. The safety profile of sofalcone even on long-term administration is well established. Therefore, it may be possible to establish a new triple therapy for H. pylori infection using sofalcone combined with antibacterial drugs and proton pump inhibitors.

Helicobacter pylori infection delays the healing of acetic acid-induced gastric ulcer in Japanese monkeys

To clarify the relationship between Helicobacter pylori and the healing of gastric ulcers, we investigated the healing of acetic acid-induced gastric ulcers in the antral mucosa of Japanese monkeys (n = 5) infected with H. pylori and in control monkeys without H. pylori infection (n = 6). Using H. pylori-infected Japanese monkeys as an experimental model, gastric ulcers were induced endoscopically with acetic acid. Healing of ulcers and factors that influenced healing were studied. Continuous colonization with H. pylori was confirmed in the infected group throughout the observation period; no H. pylori were isolated from the gastric mucosa of the control group. White scarring was not observed in any infected monkeys 4 weeks after ulcer formation, but was observed in one (20%) of five monkeys at 6 weeks and in all five monkeys eight weeks after ulcer formation. In the control group, white scarring was observed in one (16.7%) of six monkeys at 4 weeks and in six monkeys at 6 (P < 0.01 vs infected group) and 8 weeks. The ammonia concentration of the gastric secretions and the grade of inflammation were significantly increased in the H. pylori-infected group compared with the control group (P < 0.01 and P < 0.001, respectively). The volume of intracellular PAS-positive substance was decreased (P < 0.025-0.01) at the ulcer margin in the infected group compared with the ulcer margin in the control group. The proliferation of gastric epithelial cells was markedly accelerated at the ulcer margin in the infected group compared with the ulcer margin in control group (P < 0.025-0.01). Our results strongly suggest that H. pylori infection delays the healing of gastric ulcers.

Expression of vacuolating cytotoxin in clinical isolates of Helicobacter pylori

Our objective was to determine whether the prevalence of vacuolating cytotoxin production differed among Helicobacter pylori isolates obtained from patients with chronic gastritis, gastric ulcer, or duodenal ulcer. We examined the vacuolating cytotoxin production of 114 clinical H. pylori isolates in rabbit gastic epithelial cells (RGECs). We also tested two positive control strains (NCTC 11637 and NCTC 11916). Seventy-four of the 114 H. pylori clinical isolates (64.9%) produced intracellular vacuolation in RGEC cells, but there was no significant difference in the prevalence of intracellular vacuolation among the isolates of patients with chronic gastritis, gastric ulcers, and duodenal ulcers. We found no strong correlation between vacuolating cytotoxin production and peptic ulceration.