Antibodies to Cag A protein are not predictive of serious gastroduodenal disease in Indian patients

OBJECTIVE

The present study was aimed at assessing the predictive utility of anti-Cag A antibodies in differentiating patients of duodenal ulcer (DU) and non ulcer dyspepsia (NUD) from asymptomatic controls in a developing country.

METHODS

Sera from 120 subjects were tested for antibodies to Cag A using the immunodominant portion of a recombinant 37.5 kDa fusion protein by ELISA, in endoscopically proven cases of DU and NUD and healthy controls.

RESULTS

The observed optical density (OD) in DU and NUD patients was 1,947 and 1,960 respectively, which was higher than that observed in controls (p < 0.01), but there was no difference in the anti-Cag A antibody titers between DU and NUD patients.

CONCLUSION

Anti-Cag A antibodies do not seem to discriminate duodenal ulcer patients from non ulcer dyspepsia in the Indian population.

Effect of immunization against the amino-terminal peptide (alpha N) of the alpha 43-subunit of inhibin on follicular atresia and expression of tissue inhibitor of matrix metalloproteinase (TIMP-1) in ovarian follicles of sheep

Ewes actively immunized against alpha N, the N-terminal peptide of inhibin alpha 43 precursor, have lowered fertility associated with ovulation failure, restricted tissue remodelling and reduced matrix metalloproteinase-2 activity in the follicular fluid at the time of expected ovulation. This could be due to altered ratios of matrix metalloproteinase-2 and tissue inhibitor of matrix metalloproteinase (TIMP-1), or to the onset of atresia in antral follicles destined to ovulate. The objectives of the present study were to investigate the effects of immunization against alpha N on the localization of TIMP-1 in ovine follicles, and on follicular growth and atresia in the follicular phase. Ewes were either immunized against alpha N or remained as controls and the ovaries were removed before (0, n = 4) and at 12 h (n = 4) and 24 h (n = 4) after hCG administration in a synchronized follicular phase, 48 h after removal of intravaginal pessaries. Observations were made on a single section taken through the largest follicle present in the ovaries of each ewe. There were no healthy antral follicles > 1 mm in immunized ovaries (0/29) compared with controls (16/31) (P < 0.001), whereas the proportion of healthy antral follicles < 1 mm was the same in each group (9/19 versus 5/12). TIMP-1 immunoactivity was localized in large luteal cells, smooth muscle and endothelial cells, and in all antral follicles, including oocytes. At the time of hCG administration, no TIMP-1 immunoreactivity was detected in the apical region of the follicular wall of large follicles (> 6 mm) compared with the rest of the follicle wall, but staining appeared in the apical granulosa layer 24 h later. In newly formed corpora lutea, TIMP-1 expression was found along the invaginating vascular layer. There was no effect of immunization on the patterns of TIMP-1 immunoreactivity, suggesting that changes in TIMP-1 are not involved in the effects of alpha N. These data are consistent with a paracrine role for alpha N in the selection and atresia of antral follicles, and for TIMP-1 in tissue reorganization and steroidogenesis at the time of ovulation.

Lansoprazole and secnidazole with clarithromycin, amoxycillin or pefloxacin in the eradication of Helicobacter pylori in a developing country

BACKGROUND

A number of triple drug regimens using proton pump inhibitors and two antibiotics have been evaluated in the West and reported to achieve Helicobacter pylori eradication rates of over 90%. In developing countries however, these combinations have neither been well evaluated, nor the optimum treatment for H. pylori infection well defined.

AIM

To compare the combination of a proton pump inhibitor with a nitroimidazole and another antibiotic in eradicating H. pylori infection and healing duodenal ulcer.

METHODS

Sixty consecutive patients with active duodenal ulcer who were positive for H. pylori (by rapid urease test and 14C-urea breath test) were randomized into three treatments groups: (1) LAS (n=21): lansoprazole 30 mg o.m., amoxycillin 500 mg q.d.s. and secnidazole 2 g on alternate days for 2 weeks; (2) LCS (n=18): lansoprazole 30 mg o.m., clarithromycin 500 mg b.d. and secnidazole 2 g on alternate days for 1 week; (3) LPS (n=21): lansoprazole 30 mg o.m., pefloxacin 400 mg o.m. and secnidazole 2 g on alternate days for 2 weeks. Urease and breath tests were performed at 0, 6 and 12 weeks to check for H. pylori eradication.

RESULTS

Intention-to-treat eradication rates were as follows: LAS 86%, LCS 83%, LPS 71%; the overall ulcer healing rate was 90% at 6 weeks.

CONCLUSIONS

High H. pylori eradication rates were achieved using the amoxycillin- and clarithromycin-based therapies. Fewer side-effects, better compliance and low cost favoured the amoxycillin-based therapy.

Pulmonary tuberculosis treated with directly observed therapy: serial changes in lung structure and function

OBJECTIVES

(1) To correlate structure (CT) with function in pulmonary tuberculosis (TB), and (2) to describe the evolution of structural and functional abnormalities when pulmonary TB is treated with directly observed therapy.

SUBJECTS AND METHODS

Twenty-five patients with drug-susceptible pulmonary TB, 15 cavitary and 10 noncavitary, were studied prospectively. Conventional CT and pulmonary function testing (spirometry, diffusing capacity, and arterial blood gases) were performed at baseline, and after 1 and 6 months of directly observed therapy.

RESULTS

All but one patient with noncavitary miliary TB had CT evidence of endobronchial disease, and all patients with cavitary disease had coexistent reduced lung attenuation, the latter presumably a result of gas trapping, hypoxic vasoconstriction, and vascular injury. Functional impairment was minimal and in proportion to the number of diseased segments and cavitary volume. Bronchiectasis was significantly more likely to complicate cavitary than noncavitary disease (64 vs 11%; p<0.05).

CONCLUSIONS

CT findings correlate well with function in pulmonary TB. Physiologic data were consistent with the concept that pulmonary TB is an endobronchial disease that causes parallel reductions in ventilation and perfusion. This concurrent involvement of both airways and contiguous pulmonary blood supply offers an explanation for the minimal respiratory limitation experienced by these patients despite often extensive lung disease. Supervised therapy of drug-susceptible disease results in minimal structural and functional residua.

Alu elements in a Plasmodium vivax antigen gene

Plasmodium vivax is a very common human malaria parasite but it is poorly characterized at the molecular level. Here, we describe the isolation and characterization of an antigen coding gene of P. vivax which contains Alu elements. This gene, called Pv-Alu, is expressed during the erythrocytic phase of the parasite. The encoded 200 amino acid long polypeptide is highly hydrophobic, contains transmembrane domains, and is rich in leucine (19.4%), serine (15.9%), proline (15.4%) and phenylalanine (15.4%). The 5'-untranslated region and part of the 3'-end coding region of Pv-Alu show significant homology to different Alu families. The presence of Alu elements in the coding region of a parasite antigen gene is significant from a functional and evolutionary viewpoint.

Clinical evaluation of the leukogard-6 arterial line filter

To assess the leucocyte depleting characteristics of the Pall leukogard-6 arterial line leucocyte depleting filter, it was incorporated in the extracorporeal circuit of 30 patients with normal left ventricular function scheduled for elective coronary artery bypass grafting. The Intersept Medtronic 40 micro arterial line filter which is normally used at our centre was used in 29 similar patients. Blood samples were drawn for estimation of total and differential leucocyte and platelet counts, blood gas analysis, superoxide dismutase levels and renal function tests at various time points. Ventilation time, length of ICU stay and incidence of infection were recorded. No significant difference was observed between the two groups regarding total leucocyte count, percentage of neutrophils and lymphocytes, platelet count, arterial oxygen and carbon dioxide tensions, pulmonary vascular resistance, ventilation time and postoperative infection. A significant difference was observed between the prebypass levels of superoxide dismutase 89.63 +/- 49.69 SOD units/ml, and 24 hours post bypass levels 66.62 +/- 36.23 SOD units/ml, (p<0.01), in the control group. In the leukogard filter group, the difference between pre bypass levels of superoxide dismutase 82.47 +/- 50.58 SOD units/ml and 24 hours post bypass 73.44 +/- 41.10 SOD units/ml, (p>0.05), was not significant. This indicated less free radical activity in the leukogard filter group, but this beneficial effect of the leukogard-6 filter did not correlate with any clinical parameter. In this study, the leukoard-6 filter did not exhibit leucocyte depleting characteristics following cardiopulmonary bypass and is unlikely to be of significant advantage when incorporated in the extracorporeal circuit for coronary artery bypass grafting, in patients with normal ejection fraction.

Eradication of H. pylori in a developing country: comparison of lansoprazole versus omeprazole with norfloxacin, in a dual-therapy study

OBJECTIVES

Lansoprazole, a newer benzimidazole, is more potent than omeprazole in its anti-Helicobacter pylori effect in vitro. The present study was aimed at assessing its efficacy in a developing country.

METHODS

Fifty patients were randomized to receive either lansoprazole or omeprazole, with norfloxacin for 2 wk; the ulcer healing rates, H. pylori eradication rates, and recurrence rates were compared over a 6-month period.

RESULTS

Both lansoprazole and omeprazole were equally effective in inducing healing of ulcer (96.1 vs 95.5%, p > 0.05) and eradicating H. pylori (76.9 vs 63.9%, p > 0.05), with very low recurrence rates over a 6-month follow-up period.

CONCLUSIONS

Either lansoprazole or omeprazole combined with norfloxacin is effective in eradicating H. pylori in a high percentage of cases of duodenal ulcer, with little difference between the two proton pump inhibitors.

HLA association and occurrence of autoantibodies in Asian-Indian patients with ulcerative colitis

OBJECTIVES

The purpose of the present study was to determine the profile of HLA class I antigens, antinuclear antibodies (ANA), and antineutrophil cytoplasmic antibodies (ANCA) in ulcerative colitis (UC) patients from Northern India.

METHODS

The study consisted of 100 UC patients with or without extraintestinal manifestations. Data on HLA, ANA, and ANCA were analyzed with respect to age at onset, sex, duration of disease, and occurrence of extraintestinal manifestations, and data were correlated with those of healthy controls from the same population.

RESULTS

The most common extraintestinal manifestations in order of occurrence were arthralgia (53.8%), ocular lesions (18%), sacroiliitis (12.7%), hepatobiliary (7.7%), cutaneous (5%), and vascular (2.6%). ANA and ANCA were positive in only 3% of cases. Of the HLA class I antigens, HLA-A19 was significantly increased in UC patients compared with controls (63.4% vs. 33.5%, p < 0.001, RR = 3.4), particularly its subtype HLA-A33 (20.7% vs. 4%, p < 0.001, RR = 6.3). There was no deviation in the frequency of HLA-B locus antigens, whereas HLA-Cw6 was increased significantly in patients compared with controls (14.6% vs. 3.5%, p < 0.001, RR = 4.4).

CONCLUSIONS

The occurrence of extraintestinal manifestations in Indian patients with UC is similar to that reported elsewhere, although ANA and ANCA positivity is lower. HLA studies revealed that A19(33) and Cw6 are associated with UC.

Bifid pancreas: a case report

Bifid pancreas is a rare anatomical anomaly in which the main pancreatic duct is bifurcated along its length. Although the pancreatographic appearance has been described in the literature, there is no mention of the computerised tomographic appearance of this condition. We report a case of bifid pancreas with the ERCP and CT appearances, who also had alcohol induced changes of chronic pancreatitis.

Changes in adenine nucleotides during hemorrhagic shock and reperfusion

Certain tissues are known to be susceptible to shock-induced damage: liver, small bowel mucosa, and small bowel wall. This study was done to assess the changes in adenine nucleotides induced by hemorrhagic shock. Male Sprague-Dawley rats (n = 21; 300-350 g) were anesthetized with sodium pentobarbital (50 mg/kg, ip) and mechanically ventilated. The external jugular vein and common carotid artery were cannulated. Laparotomy was done. Hemorrhagic shock was induced by withdrawing blood into a heparinized syringe until a mean arterial blood pressure of 40 mm Hg was obtained and was maintained for 30 min by continued withdrawals. Shed blood was then reinfused through the venous catheter. No additional fluid was administered. The animals were observed for another 60 min. Throughout the procedure, biopsies were taken of liver and small bowel. The small bowel biopsies were separated into mucosal and wall fractions. Nucleotides were extracted. ATP, ADP, AMP, adenosine, inosine, xanthine, and hypoxanthine were measured with gradient HPLC. Cellular ATP concentrations decreased significantly during shock (P < 0.05). Liver ATP dropped from 8.93 +/- 0.55 to 2.91 +/- 0.16 micromol/g dry tissue (mean +/- SEM) (33%), small bowel mucosal ATP from 9.40 +/- 1.04 to 3.26 +/- 0.21 (35%), and small bowel wall ATP from 5.47 +/- 0.36 to 2.74 +/- 0.18 (50%). The nucleotide response to shock in small bowel mucosa was closer to that of liver than to that of small bowel wall. After reperfusion, ATP levels were partially restored in liver, small bowel mucosa, and small bowel wall, but not to preshock values. All of the metabolites (adenosine, inosine, hypoxanthine, and xanthine) increased during shock (P < 0.05), and did not return to preshock levels after reperfusion. The abnormalities in ATP and its metabolites, and their persistence after reperfusion, suggest a possible mechanism for the production of postshock damage.

The human ovarian granulosa cell: a stereological approach

The human ovarian granulosa cell is perhaps the most widely studied endocrine cell, but little quantitative structural information exists for this cell. In the present study new and traditional stereological probes have been employed to provide quantitative structural information on these functionally important cells. Granulosa cells were obtained from follicular aspirations from 10 women during in vitro fertilisation procedures. Initially 2 methods were used to estimate the mean nuclear volume of these cells: the mean number weighted nuclear volume was estimated by the Selector and the mean volume weighted nuclear volume by the point sampled intercept method. It was found that the difference between the 2 volume estimates was only 8.5%. The volume weighted mean nuclear volume was used as an estimate of nuclear volume. This was subsequently corrected (taking the percentage difference as the empirical bias) and combined with fractional cell volumes (Vv) to produce estimates of cell, mitochondrial, lipid and nucleolar volume. The proportion of the cell occupied by the nucleus had a remarkably low interindividual variation (CV = 7.6%). The proportion of the nucleus occupied by euchromatin also had a striking low variation (CV < 6%). All other cellular parameters had CVs of less than 35%. The lipid composition of these cells showed the greatest interindividual variability, with a CV of 42% for relative and 54% for absolute volume. The present study outlines a simple protocol for the quantitation of granulosa cell structure using new unbiased stereological probes and providing baseline structural information.

Intensive care unit admission following successful cardiopulmonary resuscitation: resource utilization, functional status and long-term survival

A retrospective review of consecutive admissions (n = 285) to a university hospital intensive care unit (ICU) following cardiopulmonary resuscitation was conducted to determine long-term outcome, length of stay (LOS), and ICU resource consumption. Ninety-four patients (33%) survived to hospital discharge. Hospital survivors had longer ICU LOS than non-survivors (5.1 +/- 0.8 vs. 2.8 +/- 0.4 days, P < 0.001) and longer hospital stays (22.5 +/- 3.7 vs. 2.9 +/- 1.2 days, P < 0.001). Average laboratory and pharmacy costs per admission were greater in hospital survivors than non-survivors. Most patients returned to their pre-arrest homes functionally independent and 58% of hospital survivors were alive 2 years after discharge. It is possible that attempts to appropriately limit therapy in patients with poor prognosis may help direct resources towards patients who will benefit.

Pancrease divisum: five years' experience in a teaching hospital

AIM

To study the frequency and significance of pancreas divisum.

METHODS

Retrospective analysis of all pancreatograms carried out between July 1989 and June 1994.

RESULTS

The 809 pancreatograms performed included 207 in patients with pancreatitis (acute 74, chronic 133), 330 with biliary disease, 238 with obscure abdominal pain and 34 with pancreatic malignancy. Of these, 30 patients (3.7%) were diagnosed to have pancreas divisum - 26 had type I variant, one had type II variant and three had type III variant. Accessory papillary cannulation was attempted in 10 patients; 8 were successful, with dorsal ductography confirming pancreas divisum in all of them. Two of these 8 patients had changes of chronic pancreatitis in the dorsal duct. The frequency of pancreas divisum in patients with pancreatitis (19 of 207, 9.2%) was significantly higher than in patients with biliary diseases and those with obscure abdominal pain (11 of 568, 1.9%; p < 0.001).

CONCLUSIONS

Pancreas divisum is not an uncommon condition in India and its frequency in patients with idiopathic pancreatitis is higher than that in patients with other abdominal conditions. It should be looked for in any case of idiopathic pancreatitis.

Biliary obstruction due to pancreatic insulinoma

Pancreatic insulinomas are rare tumors and their association with polycystic disease of the liver is uncommon. We report here a patient with pancreatic insulinoma with hepatic metastasis and biliary obstruction presenting with neuroglycopenic symptoms and cholestasis on a background of polycystic liver disease.

Effect of pentoxifylline on tissue injury and platelet-activating factor production during ischemia-reperfusion injury

PURPOSE

Pentoxifylline lessens the metabolic derangements associated with ischemia-reperfusion injury. This study evaluated the effects of pentoxifylline on platelet-activating factor (PAF) production and tissue injury during skeletal muscle ischemia-reperfusion injury.

METHODS

The isolated canine gracilis muscle model was used. Group 1 muscles were subjected to 5 hours of ischemia and 20 hours of reperfusion (n = 10); group 2 muscles received pentoxifylline, 15 mg/kg, systemic infusion 10 minutes before reperfusion (n = 6); group 3 muscles received pentoxifylline, 25 mg/kg, systemic infusion 10 minutes before reperfusion (n = 6). PAF was measured from muscle venous effluent by the scintillation proximity assay method. Muscle injury was assessed by vital staining and planimetry.

RESULTS

PAF levels in group 2 were decreased at 10, 15, and 30 minutes of reperfusion compared with group 1 but did not reach significance. PAF levels in group 3 were decreased at all times of reperfusion compared with group 1 but attained significance only at 10 minutes of reperfusion (p < 0.05). No significant differences in muscle weight were noted among the three groups. No differences in the extent of muscle necrosis was observed between group 1 (77.26% +/- 20.38%) and group 2 (60.49% +/- 23.97%) (p = 0.08); there was a significant reduction in the extent of muscle necrosis in group 3 (44.55% +/- 21.47%) compared with group 1 (p < 0.05).

CONCLUSIONS

The administration of pentoxifylline at 25 mg/kg before reperfusion of ischemic skeletal muscle decreased significantly the extent of muscle necrosis and PAF levels in the venous effluents at all times of reperfusion (significantly at 10 minutes). These results suggest that pentoxifylline may decrease tissue injury of ischemia-reperfusion by inhibiting the production of PAF during critical periods of reperfusion.

Lichenoid photoeruptions in human immunodeficiency virus infection

BACKGROUND

The clinical features of lichenoid eruptions in the setting of human immunodeficiency virus (HIV) infection are poorly described. Idiopathic lichen planus is rarely reported. All patients (n = 32) with a histologic diagnosis of a lichenoid eruption or photodermatitis at the University of California, San Francisco, over a 15-month period were reviewed and studied.

OBSERVATIONS

Twelve of the 32 patients were HIV infected, and all 12 had photodistributed eruptions. Ten of 12 patients had received photosensitizing medication (usually nonsteroidal anti-inflammatory drugs or sulfamethoxazole/trimethoprim) at the onset of eruption. Most patients were black (10 of 12), and all had acquired immunodeficiency syndrome and a helper T-cell count of less than 50 cells per cubic milliliter. Nine patients had lichenoid eruptions, two showed histopathologic features of lichen niditus, and one had a photodistributed subacute dermatitis. Two patients with lichenoid eruptions developed marked depigmentation. No cases of lichen planus were found in HIV-infected persons.

CONCLUSION

Lichenoid photoeruptions are seen in advanced HIV disease (CD4, < 0.05 x 10(9)L), and black patients are disproportionately affected. Idiopathic lichen planus in HIV-infected patients seems to be less common than lichenoid photoeruptions. Previously reported cases of idiopathic lichen planus in HIV-infected patients may represent lichenoid photodermatitis.

Electrotransjection of pp60v-src monoclonal antibody inhibits activation of phospholipase C in platelets. A new mechanism for platelet-activating factor responses

Antibodies to pp60v-arc and phosphotyrosine were introduced into rabbit platelets using an electropermeabilization technique. The presence of these antibodies inside platelets was detected by flow cytometry. Platelet-activating factor (PAF)-stimulated phospholipase C activity (inositol phosphate production) and aggregation were dramatically inhibited in platelets transjected with either of these antibodies. Incubation of these antibodies with intact cells (i.e. nonpermeabilized) or electrotransjection of several nonspecific antibodies/agents (e.g. goat anti-mouse IgG, mouse serum, human platelet glycoprotein Ib monoclonal antibody, and fetal calf serum) into platelets had no effect on the PAF responses. trpE (another isotype-matched control antibody of pp60v-src) and pp56lck polyclonal antibody (another src-related kinase not present in platelets) also had no effect on PAF-induced aggregation and inositol phosphate production in permeabilized platelets. This indicates that the effect of internalized pp60v-src antibody is direct and specific in platelets. Stimulation of platelets by PAF increased the association and phosphorylation of both pp60c-src (60 kDa) and phospholipase C gamma 1 (145 kDa). This study provides the first evidence in platelets for a direct and specific involvement of pp60c-src in PAF-mediated phospholipase C activation and aggregation response.