Long-term ciprofloxacin treatment for the prevention of biliary stent blockage: a prospective randomized study

OBJECTIVE

In vitro experimental and animal studies have shown that quinolones reduce the adherence of bacteria on a polyethylene tube and prevent stent blockage. Our aim was to see whether ciprofloxacin prevents stent blockage in patients with malignant stricture of the biliary tract.

METHODS

Patients with inoperable biliary or pancreatic tumor not involving the bifurcation of the common hepatic duct were recruited. They were randomized to receive either endoscopic stenting alone or stenting with prophylactic treatment of ciprofloxacin (200 mg i.v. before stenting, followed by 250 mg orally twice per day). In each follow-up visit, clinical symptoms of cholangitis were documented and blood samples taken for blood counts, serum levels of bilirubin, and alkaline phosphatase. Stent blockage was defined as clinical symptom(s) of cholangitis with biochemical or radiological evidence of stent dysfunction.

RESULTS

Fifty-eight patients were recruited into the study. Three patients in the stenting group and three in the ciprofloxacin group were excluded after randomization. Eleven patients received stenting alone and five patients receiving ciprofloxacin had previous endoscopic stenting. Thirteen patients (50%) in the ciprofloxacin group and eight patients (31%) in the stenting group died before stent blockage. Ten patients (38%) in each group had stent blockage during the follow-up at 20 wk. The median stent patency was 11.6 wk and 11.9 wk in the ciprofloxacin group and the stenting group, respectively. Kaplan-Meier analysis of stent patency showed no difference between the two groups. Among patients who received endoscopic stenting for the first time, there was a trend favoring ciprofloxacin treatment, but the difference was not significant. The 30-day and 20-wk mortality between the groups were comparable.

CONCLUSION

Long-term use of ciprofloxacin does not prevent blockage of polyethylene biliary stents.

Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy

BACKGROUND AND STUDY AIMS

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the mainstays in the diagnosis and treatment of hepatobiliary and pancreatic diseases, and is also increasingly used for patients with previous Billroth II gastrectomy. The aim of this study was to review our experience of ERCP in patients with Billroth II gastrectomy, and the complications associated with this procedure.

PATIENTS AND METHODS

The records of 110 patients with Billroth II gastrectomy, treated between January 1993 and December 1997, were received retrospectively. Details noted included indications for ERCP, therapeutic interventions, causes of failure, and complications.

RESULTS

A total of 110 patients underwent ERCP; the total number of ERCP attempts was 185. The major indications for ERCP were cholangitis (31%), common bile duct stones (22%), and jaundice (15%). The endoscope was successfully passed up to the papilla in 134 examinations (71%), and selective cannulation was successful in 122 of these (66%). There were 63 (34%) failed ERCP attempts. Causes of failure were: difficulty in entering the afferent loop (n = 19, 10%), failure to enter the duodenum (n = 23, 12%), endoscope-related bowel perforation (n = 9, 5%), and failed cannulation (n = 10, 6%). The other two failures were caused by desaturation in the patient, and inability to distend the duodenum. The major complication of the procedure was perforation, which occurred in 11 examinations (6%). Of these perforations, nine occurred in the small bowel while the endoscope was being manipulated through the afferent loop; these patients required laparotomy. Two patients had retroduodenal perforations, one occurring after sphincterotomy and one after cannulation. Both patients were successfully managed conservatively. Three patients suffered bleeding after sphincterotomy (3/185 procedures, 1.6%), and one patient developed acute pancreatitis. These were managed conservatively. The overall complication rate was 8%. There were two deaths among the patients with small-bowel perforations, and consequently an overall mortality rate of 1% (2/185 procedures).

CONCLUSIONS

Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was being manipulated through the afferent limb. Such perforations are intraperitoneal and require surgical intervention.

Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis

OBJECTIVE

The aim of this study was to investigate oral manifestations and salivary changes in patients with end-stage renal disease undergoing hemodialysis.

STUDY DESIGN

Eighty-two patients undergoing hemodialysis for renal insufficiency were examined; 22 of these patients were randomly selected for salivary tests. Unstimulated whole saliva and stimulated parotid saliva were collected, and flow rate, pH, and buffer capacity were examined. Twenty-two healthy volunteers were included as controls.

RESULTS

Uremic odor, dry mouth, and taste change were common symptoms. Petechia and/or ecchymosis and increase of tongue coating were major signs. The flow rates of unstimulated whole and stimulated parotid saliva were decreased in the patient group. The pH and buffer capacity of unstimulated whole saliva were increased in the patient group, but stimulated parotid saliva did not show any significant differences.

CONCLUSIONS

Patients with end-stage renal disease undergoing hemodialysis showed apparent oral and salivary changes. The results help us understand the relationship between oral changes and renal insufficiency.

New wire-guided basket for intrahepatic stone extraction

BACKGROUND

Endoscopic extraction of intrahepatic ductal stones with conventional stone retrieval baskets sometimes is difficult when the stones are deep in the segmental ducts or in a tortuous duct. We evaluated the use of a new wire-guided basket for endoscopic bile duct stone extraction.

METHODS

The new wire-guided basket has a separate lumen for the guidewire on one side of the catheter. It is rail-loaded and advanced over a guidewire into the desired segmental duct. After they are engaged, the stones are dragged into the duodenum and the guidewire is left in the segmental duct. The basket then can be reinserted into that particular ductal segment over the wire for further stone extraction.

RESULTS

The basket was used to treat three patients. Two patients had multiple intrahepatic stones. Repeated passage of the basket back to the desired location was accomplished without difficulty. All stones were removed successfully.

CONCLUSION

The new wire-guided basket is a useful device for removing intrahepatic stones, particularly from patients with multiple ductal stones.

One-week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC-MACH study

BACKGROUND

We have previously shown that ranitidine bismuth citrate (RBC)-based triple therapy is comparable to proton pump inhibitor-based triple therapy in eradicating Helicobacter pylori infection.

AIM

To test the efficacy of different combinations of antimicrobials with RBC in the treatment of H. pylori infection.

METHODS

Dyspeptic patients with H. pylori infection were prospectively randomized to receive one of the following regimens: (i) RBC 400 mg, amoxycillin 1 g, clarithromycin 500 mg [RAC]; (ii) RBC 400 mg, metronidazole 400 mg, clarithromycin 500 mg [RMC]; (iii) RBC 400 mg, metronidazole 400 mg, tetracycline 1 g [RMT] (all given twice daily for 1 week); or (iv) RBC 400 mg plus clarithromycin 500 mg twice daily for 2 weeks [RC-2]. Endoscopy (rapid urease test and culture) and 13C-urea breath test (UBT) were performed before randomization. Four weeks after finishing medication, the 13C-UBT was repeated in all cases and endoscopy was offered to patients with peptic ulcers.

RESULTS

Four hundred patients were randomized but in two (one in the RAC group and one in the RMC group) H. pylori infection was not confirmed. Successful eradication of H. pylori (intention-to-treat analysis and 95% CI) of RAC (86% [79-93%]), RMC (90% [84-96%]), RMT (79% [71-87%]) and RC-2 (82% [75-90%]) were comparable, with a trend favouring clarithromycin-containing triple therapy regimens. Among 276 isolates tested for antibiotic sensitivity, primary resistance to metronidazole, clarithromycin and amoxycillin was found in 56%, 2% and 0.4%, respectively. When given RMC or RMT, patients infected by metronidazole-resistant H. pylori had success in eradicating H. pylori similar to patients infected by metronidazole-sensitive H. pylori.

CONCLUSION

One-week RBC triple therapy is effective in curing H. pylori infection.

Assessing chemotherapy response of squamous cell oesophageal carcinoma with spiral CT

45 patients with squamous cell carcinoma of the oesophagus were examined prior to, and following, pre-operative chemotherapy by spiral CT. Oesophageal CT was performed following gaseous distention of the oesophagus. TNM stage and perceived resectability on CT before and after chemotherapy were compared and related to surgical resectability and pathological staging. T-stage changed in 26% and N-stage changed in 9% of tumours after chemotherapy. Post-chemotherapy CT predicted pathological T-stage with an accuracy of 88% and N-stage with an accuracy of 84%. Six of 14 tumours considered irresectable on CT pre-chemotherapy were considered resectable on post-chemotherapy CT. Five of these six tumours were resectable at surgery. Post-chemotherapy CT predicted surgical resectability with an accuracy of 88%, the main pitfall being underestimation and overestimation of tracheobronchial invasion. CT prediction of chemotherapy response as judged by change in tumour volume was compared with a quantitative pathological assessment of chemotherapy response. 93% of oesophageal tumours changed volume after chemotherapy with 51% having a volume reduction of > or = 50%. However, no correlation was found between tumour volume reduction on serial CT examinations and either a quantitative pathological assessment of tumour response or patient survival.

Prevalence and distribution of Helicobacter pylori in gastroesophageal reflux disease: a study from the East

OBJECTIVES

The relationship between Helicobacter pylori infection and gastroesophageal reflux (H. pylori) disease (GERD) is controversial. In Asian populations, the prevalence of H. pylori infection is high and GERD is relatively uncommon. The aim of this study was 1) to test the hypothesis that H. pylori protects the esophagus against GERD, and 2) to study the pattern of H. pylori colonization and gastritis in GERD.

METHODS

We conducted a prospective case-control study in which patients with GERD and asymptomatic controls were compared for the prevalence of H. pylori infection. Diagnosis of GERD was based on symptoms of heartburn that improved with acid-suppressive therapy and/or endoscopic evidence of erosive esophagitis. H. pylori status was determined by serology and, when endoscopy was indicated, was confirmed by rapid urease test and histology. Gastric biopsies were examined under hematoxylin and eosin and Giemsa stains. Density of H. pylori colonization and activity of gastritis at different parts of stomach were graded and compared according to Updated Sydney system.

RESULTS

A total of 106 patients with GERD and 120 age- and sex-matched, asymptomatic controls were enrolled. The prevalence of H. pylori infection was significantly lower in GERD patients (31%) compared with controls (61%, p < 0.001, odds ratio 0.229, 95% confidence interval 0.13-0.41). H. pylori-infected GERD patients showed significantly more severe gastritis in the antrum than in other parts of stomach (mean inflammatory scores: antrum; 3.3 +/- 1.63*, body; 1.85 +/- 1.31; fundus; 1.65 +/- 0.58; cardia, 1.65 +/- 1.39; *p < 0.005). H. pylori colonization was found less commonly and at lower density at the cardia compared with other parts of the stomach.

CONCLUSIONS

H. pylori infection protects against the development of GERD, and carditis is unlikely to play an important role.

A study on the rotational torque movement of mandible in patients with TMJ closed lock

The mandibular rotational angle and distance were measured during various movements of temporomandibular joint (TMJ) closed lock patients (17 women, 23.9 +/- 6.6 years). The measurements were compared with those of the healthy controls (18 women, 24.0 +/- 1.4 years) using the BioPAK system (BioResearch Inc. Milwaukee, USA), which can analyze mandibular rotational torque movements. During maximum mouth opening movement, the parameters of the patient group were significantly larger than those of the control group in horizontal plane (p < 0.05) but vice versa in frontal plane (p < 0.001). During protrusive movement, the parameters of patients were significantly larger than those of control group in frontal and horizontal plane (p < 0.01, p < 0.05). During lateral excursive movement to the affected side of patients, the parameters were significantly larger than those to the unaffected side in frontal plane (p < 0.05).

Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension

BACKGROUND

Azygos blood flow is an index of blood flow through gastroesophageal collateral vessels and varices in portal hypertension. Conventional measurement of azygos blood flow involves catheterization of the azygos vein. We studied the feasibility of assessing azygos blood flow with color Doppler endosonography and of monitoring the effects of vasoactive agents on azygos blood flow.

METHODS

Patients with portal hypertension were examined by means of linear array color Doppler endoscopic ultrasonography (EUS). Patients who had taken propranolol or nitrates in the 4 weeks before the day of measurement of azygos blood flow were excluded. After identification of the azygos vein and recording of baseline readings of mean arterial blood pressure, pulse rate, and azygos blood flow, patients were selected in a random manner to receive a bolus injection of 2 mg terlipressin, 250 microg somatostatin, or saline solution (control). Azygos blood flow was measured 1, 5, and 10 minutes after injection (AzBF-1, AzBF-5, AzBF-10).

RESULTS

Six patients were recruited in each treatment group. Basal azygos blood flow showed a positive association with the Child-Pugh grade of cirrhosis (p < 0.005). After bolus injection of terlipressin and somatostatin, there was a marked decrease in AzBF-1 (24% and 37%), AzBF-5 (42% and 19%), and AzBF-10 (40% both) compared with baseline. The control group showed no significant change in azygos blood flow.

CONCLUSIONS

Color Doppler EUS is useful in assessing azygos blood flow in portal hypertension and in monitoring the effects of vasoactive agents.

Preventing ulcer rebleeding: the role of second-look endoscopy

Whether a second-look endoscopy after initial endoscopic hemostasis is of value is controversial. Routine surveillance endoscopy on the next day and treatment of any remaining stigmata may provide marginal benefit, but existing studies are not large enough to demonstrate significant differences. Endoscopic retreatment when patients develop rebleeding may allow emergency surgery to be avoided if successful but may endanger life if further bleeding occurs. Early data indicate that surgery can be avoided in about 75% of patients by retreatment without an increase in mortality.

Evaluation of three commercial enzyme-linked immunosorbent assay kits for diagnosis of Helicobacter pylori in Chinese patients

Most of the commercial serological assays for H. pylori are developed and validated in western countries. We evaluated the accuracy of three popular commercial ELISA tests for H. pylori in the Chinese population. Eighty dyspeptic patients were recruited and diagnosis of H. pylori infection was based on biopsy urease test, histology and urea breath test. Thirty-six patients (45%) were positive for H. pylori infection by two or more positive reference tests. Anti-H. pylori IgG antibody was detected by three commercial ELISA tests: GAP IgG (Bio-Rad), HM-CAP (Enteric Products) and Pyloriset EIA-G (Orion). The respective sensitivity, specificity, positive and negative predictive values of the three tests were: GAP IgG (50%, 97.4%, 93.8%, 71.7%), HM-CAP (72.7%, 68.4%, 66.7%, 74.3%) and Pyloriset EIA-G (75%, 86.4%, 81.8%, 80.9%). Despite the high accuracy reported in the West, the performance of these commercial serological tests was unsatisfactory when used in Chinese patients.

Helicobacter pylori heat shock protein A: serologic responses and genetic diversity

Helicobacter pylori synthesizes an unusual GroES homolog, heat shock protein A (HspA). The present study was aimed at an assessment of the serological response to HspA in a group of Chinese patients with defined gastroduodenal pathologies and determination of whether diversity is present in the nucleotide sequences encoding HspA in isolates from these patients. Serum samples collected from 154 patients who had an upper gastrointestinal pathology and the presence of H. pylori defined by biopsy were tested for an immunoglobulin G (IgG) serologic response to H. pylori HspA by an enzyme linked immunosorbant assay. HspA-encoding nucleotide sequences in H. pylori isolates from 14 patients (7 seropositive and 7 seronegative for HspA) were analyzed by PCR and direct sequencing of the PCR products. The sequencing results were compared to those of 48 isolates from other parts of the world. Of the 154 known H. pylori-positive patients, 54 (35.1%) were seropositive for HspA. The A domain (GroES homology) of HspA was highly conserved in the 14 isolates tested. Although the B domain (metal-binding site unique to H. pylori) resembled that in the known major variant, particular amino acid substitutions allowed definition of an HspA variant associated with isolates from East Asia. There were no associations between patient characteristics and HspA seropositivity or amino acid sequences. We confirmed in this study that the clinical outcomes of H. pylori infection are not related to HspA antigenicity or to sequence variation. However, B-domain sequence variation may be a marker for the study of the genetic diversity of H. pylori strains of different geographic origins.

A comparison study on physical properties of self-expandable esophageal metal stents

BACKGROUND

Currently available esophageal expandable stents differ in design, material, and method of deployment. We compared the expansile force and the susceptibility to buckling force in five commercially available stents.

METHODS

The Esophacoil, Wallstent, Ultraflex, Gianturco-Z and Song stents were tested. The middle sections of fully expanded stents were subjected to compression force using a universal tensile testing machine. The distortion of the stent was measured electronically and the expansile force was calculated. Bending moments were applied to the ends of the stents until buckling occurred in the inner parts. The buckling radius was measured as the radius of the inner curvature of the stent when this occurred.

RESULTS

The stents tested were significantly different in their expansile forces and buckling radii. Song stent and Gianturco-Z stent were similar due to their similar designs. Esophacoil was the strongest with regard to withstanding compressive force and angulation force, followed by Wallstent. Ultraflex stent was the weakest in expansile force but withstood angulation force better than the Song and Gianturco stents.

CONCLUSION

Esophageal stents differ greatly in their elasticity and resistance to angulation. Knowledge of their mechanical properties will be another helpful factor to consider in selecting the appropriate stent in addition to the geometry and consistency of the tumor.

Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers

BACKGROUND AND METHODS

After endoscopic treatment to control bleeding of peptic ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective, randomized study, we compared endoscopic retreatment with surgery after initial endoscopy. Over a 40-month period, 1169 of 3473 adults who were admitted to our hospital with bleeding peptic ulcers underwent endoscopy to reestablish hemostasis. Of 100 patients with recurrent bleeding, 7 patients with cancer and 1 patient with cardiac arrest were excluded from the study; 48 patients were randomly assigned to undergo immediate endoscopic retreatment and 44 were assigned to undergo surgery. The type of operation used was left to the surgeon. Bleeding was considered to have recurred in the event of any one of the following: vomiting of fresh blood, hypotension and melena, or a requirement for more than four units of blood in the 72-hour period after endoscopic treatment.

RESULTS

Of the 48 patients who were assigned to endoscopic retreatment, 35 had long-term control of bleeding. Thirteen underwent salvage surgery, 11 because retreatment failed and 2 because of perforations resulting from thermocoagulation. Five patients in the endoscopy group died within 30 days, as compared with eight patients in the surgery group (P=0.37). Seven patients in the endoscopy group (including 6 who underwent salvage surgery) had complications, as compared with 16 in the surgery group (P=0.03). The duration of hospitalization, the need for hospitalization in the intensive care unit and the resultant duration of that stay, and the number of blood transfusions were similar in the two groups. In multivariate analysis, hypotension at randomization (P=0.01) and an ulcer size of at least 2 cm (P=0.03) were independent factors predictive of the failure of endoscopic retreatment.

CONCLUSIONS

In patients with peptic ulcers and recurrent bleeding after initial endoscopic control of bleeding, endoscopic retreatment reduces the need for surgery without increasing the risk of death and is associated with fewer complications than is surgery.

Effect of exercise during the follicular and luteal phases on indices of oxidative stress in healthy women

PURPOSE

Eleven healthy nonsmoking women (24+/-1.1 yr) exercised for 30 min at 75-80% VO2max during the follicular (F) and luteal (L) phases of their menstrual cycle to determine whether menstrual phase influenced indices of oxidative stress.

METHODS

Subjects completed the exercise in a randomized order. Subjects reported between 0800 and 0900 in a postabsorptive state, rested for 15-30 min, and had a venous blood sample obtained by Vacutainer before and after exercise.

RESULTS

Resting estradiol was 54.4+/-12.0 pg.mL(-1) for F phase and was significantly higher in L phase (147.2+/-25.5 pg.mL(-1)). Plasma malondialdehyde and thiobarbituric acid substances were no different before and after exercise independent of menstrual cycle phase. No differences in resting blood total glutathione (TGSH), oxidized glutathione (GSSG), and reduced glutathione (GSH) were evident comparing the F and L phases. After exercise, TGSH decreased (P = 0.03) but reached significance only in the F phase = 8.1 %(P = 0.04), L phase = 2.5% (P = 0. 15). Exercise increased GSSG 10.5% in F (P = 0.15) and 27.8% in L phases(P = 0.01). GSH decreased after exercise independent of menstrual phase (F = 17%, L = 16%, P = 0.01).

CONCLUSION

These data suggest that 30 min of moderate-intensity exercise in female subjects can result in mild oxidative stress as indicated by blood glutathione status and that menstrual cycle phase has minimal influences on these exercise responses.

Total gastrectomy with extended lymphadenectomy for "curable" stomach cancer: experience in a non-Japanese Asian center

BACKGROUND

Gastrectomy with extended lymphadenectomy is the advocated treatment in Japan for patients with "curable" stomach cancer. Attempts in units elsewhere adopting this approach failed to show any survival advantage, and the high operative mortality has prevented global acceptance of the operation. This study examines the safety and efficacy of radical gastrectomy in a Far East center outside Japan.

STUDY DESIGN

A consecutive series of 121 patients with gastric cancer who fulfilled criteria for radical surgery had total gastrectomy with extended lymphadenectomy equivalent to D3 dissection over a 6-year period in a single unit.

RESULTS

The operation carried a morbidity of 50%, with a perioperative mortality of 5%. Survival was best predicted by tumor stage: 5-year survival for patients with intact gastric serosa was 64%, versus 10% for those with serosal penetration (p < 0.001). The majority of documented metastases occurred by transperitoneal route in serosa-positive patients, but via the hematogenous mechanisms in those who were serosa-negative.

CONCLUSIONS

Radical gastrectomy with extended lymphadenectomy carries high operative morbidity. Increased mortality occurred because of loco-regional recurrence in patients with T3/T4 diseases. Novel approaches including neoadjuvant treatment or regional therapy should be explored.

Does eradication of Helicobacter pylori impair healing of nonsteroidal anti-inflammatory drug associated bleeding peptic ulcers? A prospective randomized study

BACKGROUND

Despite the widely accepted view that Helicobacter pylori is the most important cause of peptic ulcer disease, recent studies have suggested that the microbe protects against nonsteroidal anti-inflammatory drug (NSAID)-associated gastroduodenal lesions and promotes ulcer healing. We investigated the effects of H. pylori eradication on the healing of NSAID-associated bleeding peptic ulcers.

METHODS

Chronic NSAID users presenting with peptic ulcer haemorrhage underwent endoscopy to secure haemostasis and to document H. pylori infection by rapid urease test and culture. They were prospectively randomized to receive either omeprazole (20 mg once daily) for 8 weeks or a 1-week course of triple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg, metronidazole 400 mg, all given four times daily) plus omeprazole (20 mg once daily) for 8 weeks. Endoscopy was repeated after 8 weeks. Final H. pylori status was determined by a 13C-urea breath test that was performed at least 4 weeks after discontinuation of omeprazole.

RESULTS

195 H. pylori-infected NSAID users, complicated by bleeding ulcers, were randomized to receive omeprazole alone (102) or triple therapy plus omeprazole (93). 174 patients returned for second endoscopy at 8 weeks (91 in the omeprazole group, 83 in the triple therapy group). Urea breath test was negative in 14% in the omeprazole group vs. 92% in the triple therapy group (P < 0.001). Complete ulcer healing was achieved in 88 (97%) patients in the omeprazole group and 77 (93%) in the triple therapy group (P=0. 31). On intention-to-treat analysis, ulcers were healed in 86% of the omeprazole group and 83% of the triple therapy group (P=0.50). There was no significant difference in the healing rates of gastric or duodenal ulcers between the two groups.

CONCLUSION

Eradication of H. pylori did not impair the healing of NSAID-associated bleeding peptic ulcers.

Evaluation of a selective transport medium for gastric biopsy specimens to be cultured for Helicobacter pylori

Since the means of culturing Helicobacter pylori may not be available in some laboratories, prolonging the survival of this organism during transportation is a major concern in terms of improving detection rates. A selective transport medium was evaluated for the preservation of H. pylori from 254 gastric biopsy specimens collected from a rural area in China where culturing is not feasible. Gastric biopsy specimens were inoculated in sterile broth consisting of brain heart infusion (BHI) broth, horse serum, and yeast extract supplemented with vancomycin, amphotericin B, and nalidixic acid (VAN). Of the 254 biopsy specimens, 238 were identified by histology to have H. pylori infection. Total rates of recovery of H. pylori from the H. pylori-positive gastric biopsy specimens stored in the BHI-VAN broth ranged from 76 to 46% after storage of specimens for 5 to 9 days. In conclusion, the selective medium is useful for prolonging the survival of H. pylori in gastric biopsy specimens for which immediate culture is not feasible.

Tissue injury of Injection Gold Probe

BACKGROUND

The Injection Gold Probe, which incorporates an injection needle and a bipolar electrocoagulation probe, potentially offers better anchoring of the probe for electrocoagulation. This study compares the tissue injury caused by the Injection Gold Probe with or without protrusion of the needle.

METHODS

A 10F Injection Gold Probe was applied perpendicularly on the antrum of porcine stomach. At each site of testing, one pulse of treatment at 12 W was given for 10 seconds. The extent of tissue injury was studied under different forces of application (light touch or maximal force) and different probe conditions (needle-in, needle-out, needle-out plus 1 mL saline solution injection). Each maneuver was repeated 8 times. The depth and width of tissue injury were assessed histologically by a pathologist blinded to the treatment.

RESULTS

The depth and width of tissue injury did not differ significantly with needle-in, needle-out, or needle-out plus 1 mL saline solution injection on both light touch. But the tissue injury was significantly deeper and wider with maximal force applications than with light touch under the same probe condition.

CONCLUSION

The extent of tissue injury inflicted by electrocoagulation using the Injection Gold Probe is not affected by the position of the injection needle.