The effects of ursodeoxycholic acid in patients with severe obstructive jaundice after drainage procedure

BACKGROUND

The aim of this study is to evaluate the therapeutic effect of ursodeoxycholic acid (UDCA) for patients with severe obstructive jaundice after drainage procedure.

METHODS

From September 1993 to December 1994, patients admitted with severe obstructive jaundice (serum bilirubin > 15 mg/dl) and successful drainage were enrolled into our study. They were randomly divided into two groups to receive UDCA 600 mg per day (UDCA group) or a placebo (placebo group) until operation or discharge. Bile drainage amount, clinical symptoms and signs and adverse effects of drugs were recorded daily. Biochemical tests, including albumin, total bilirubin, cholesterol, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase and prothrombin time, were checked first, on the third and seventh days, and then two weeks after drainage.

RESULTS

Thirty-eight patients (M/F = 36/ 2, mean age 66.6 +/- 6.4 years) completed the study, 18 in the UDCA group and 20 in the placebo group. There were no differences in age, sex, causes of obstructive jaundice or methods of drainage procedure between the UDCA and placebo groups. Improvement in biochemical test results were noted in both groups. However, bile drainage amount and changes in liver biochemical test, especially the decrement of serum bilirubin, were not significantly different between both groups.

CONCLUSIONS

UDCA seemed not to benefit patients with severe obstructive jaundice after successful drainage.

Prognostic value of plasma endotoxin levels in patients with cirrhosis

BACKGROUND

Endotoxemia has frequently been observed in patients with cirrhosis. Previous studies have shown that cirrhotic patients with endotoxemia have a higher mortality than those without. We evaluated the clinical value of plasma endotoxin level in predicting short-term (3 months) and long-term (2 years) survival among cirrhotic patients and compared it with the Child-Pugh score.

METHODS

Plasma endotoxin levels were determined in 102 cirrhotic patients without clinical evidence of infection by a quantitative Limulus assay. The patients were followed up for 3 months to assess short-term survival and for 2 years for long-term survival.

RESULTS

Plasma endotoxin levels increased progressively as liver function deteriorated. In short-term survival analysis, plasma endotoxin levels were significantly higher in non-survivors than those in survivors (10.6 +/- 2.2 pg/ml versus 5.8 +/- 0.5 pg/ml; P < 0.05). Both plasma endotoxin and serum bilirubin levels, but not the Child-Pugh score, were significant factors in predicting short-term survival in multivariate analysis. In long-term survival analysis, plasma endotoxin levels did not differ significantly between survivors and non-survivors (6.1 +/- 0.6 pg/ml versus 7.3 +/- 1.1 pg/ml; P > 0.05) and was not an independent predictor of long-term survival. In contrast, both Child-Pugh score and serum bilirubin levels were significant predictors of long-term survival in multivariate analysis.

CONCLUSIONS

In patients with cirrhosis, plasma endotoxin levels progressively increase as liver function deteriorates and may be useful in predicting short-term survival.

Hyperdynamic circulation of cirrhotic rats: role of substance P and its relationship to nitric oxide

BACKGROUND

It has been suggested that excessive formation of nitric oxide (NO) is responsible for the hyperdynamic circulation observed in portal hypertension. Substance P is a neuropeptide partly cleared by the liver and causes vasodilatation through the activation of the endothelial NO pathway. However, there are no previously published data concerning the plasma level of substance P in cirrhotic rats and its relationship to NO.

METHODS

Plasma concentrations of substance P and nitrate/nitrite (an index of NO production) were determined in control rats and cirrhotic rats with or without ascites using an enzyme-linked immununosorbent assay and a colorimetric assay, respectively. In addition, systemic and portal hemodynamics were evaluated by a thermodilution technique and catheterization.

RESULTS

Cirrhotic rats with and without ascites had a lower systemic vascular resistance (2.6 +/- 0.2 and 3.9 +/- 0.4 mmHg ml(-1) x min x 100 g body weight, respectively) and higher portal pressure (14.6 +/- 0.6 and 11.3 +/- 1.8 mmHg) than control rats (6.5 +/- 0.3 mmHg x ml(-1) x min x 100 g BW and 6.8 +/- 0.2 mmHg, respectively, P < 0.05), and cirrhotic rats with ascites had the lowest systemic vascular resistance. Plasma levels of nitrate/nitrite progressively increased in relation to the severity of liver dysfunction (control rats, 2.7 +/- 0.5 nmol/ml; cirrhotic rats without ascites, 5.6 +/- 1.3 nmol/ml; cirrhotic rats with ascites, 8.3 +/- 2.2 nmol/ml; P < 0.05). Cirrhotic rats with ascites displayed higher plasma values of substance P (57.7 +/- 5.9 pg/ml) than cirrhotic rats without ascites (37.9 +/- 3.1 pg/ml, P < 0.05) and control rats (30.1 +/- 1.0 pg/ml, P < 0.05). There was no significant difference in plasma substance P values between control rats and cirrhotic rats without ascites (P > 0.05). No correlation was found between plasma levels of substance P and nitrate/nitrite (r = 0.318, P > 0.05).

CONCLUSIONS

Excessive formation of NO may be responsible, at least partly, for the hemodynamic derangements in cirrhosis. Although substance P may not participate in the initiation of a hyperdynamic circulation in cirrhosis, it may contribute to the maintenance of the hyperdynamic circulation observed in cirrhotic rats with ascites.

Hemodynamic studies and esophageal morphometric analyses in portal hypertensive rats with left adrenal vein ligation

BACKGROUND

Despite many attempts to create esophageal varices in experimental animals, most of them have failed. This study investigated whether rats with partial portal vein ligation (PVL) and left adrenal vein ligation (LAL) develop hyperdynamic circulation and dilated esophageal submucosal veins as compared with sham-operated (Sham) plus LAL rats.

METHODS

Two series of experiments were performed to measure (a) systemic and portal hemodynamics and (b) the cross-sectional area of esophageal submucosal veins in Sham, PVL, Sham plus LAL, and PVL plus LAL rats. Hemodynamic studies with a thermodilution technique and esophageal morphometric analyses were performed 14 days after the operation.

RESULTS

PVL rats with or without LAL had a significantly lower mean arterial pressure and systemic vascular resistance accompanied by a significantly cardiac index and portal pressure than Sham rats with or without LAL (P < 0.05). LAL did not induce changes in mean arterial pressure, cardiac index, systemic vascular resistance, hear rate, or portal pressure in either Sham or PVL rats (P > 0.05). The mean cross-sectional area of esophageal submucosal veins in PVL rats with LAL (7340 +/- 833 microns2) was significantly larger than that in Sham rats with LAL (4236 +/- 556 microns2; P < 0.05). There was no significant difference in the mean cross-sectional area of esophageal submucosal veins between PVL and Sham rats without LAL.

CONCLUSIONS

PVL rats with LAL developed hyperdynamic circulation similar to PVL rats without LAL. In addition, PVL plus LAL rats had larger esophageal submucosal veins than Sham plus LAL rats. This study shows that the esophageal submucosal veins of the 14-day partially portal vein-ligated rats with LAL resemble the structural abnormalities observed in human esophageal varices, suggesting that this model could be useful to investigate this entity.

Lower gastrointestinal bleeding from a hepatocellular carcinoma invading the colon

Bleeding from the gastrointestinal tract due to hepatocellular carcinoma invasion is unusual. We describe a 71-year-old man who had bloody stools caused by a hepatocellular carcinoma that directly invaded the transverse colon. The diagnosis was confirmed by colonoscopy and tissue examination. Our patient is the first with lower gastrointestinal bleeding from a hepatocellular carcinoma during the natural course of the tumor.

Clinical evaluation of primary biliary cirrhosis in Chinese patients without serum anti-mitochondrial antibody

BACKGROUND

Primary biliary cirrhosis (PBC), a chronic, progressive, cholestatic liver disease characterized by frequent presence of the anti-mitochondrial antibody (AMA), is rarely seen in the Asian population. Whether or not the presence of AMA alters the clinical, serological and histological features of the disease remains unclear.

METHODS

During the 25-year period from 1972 to 1996, 71 Chinese patients with PBC who were diagnosed clinically and/or histologically were reviewed. Seventeen (24%) of them repeatedly tested negative for serum AMA. Clinical, biochemical, immunological, histological data and treatment response to ursodeoxycholic acid were compared between PBC patients with positive and negative serum AMA.

RESULTS

Mean serum immunoglobulin M (IgM) level was significantly lower in AMA-negative PBC patients when compared with AMA-positive PBC patients (422 +/- 163 vs. 651 +/- 412 mg/dL, p = 0.042). Serum anti-nuclear antibodies (ANA) were positive in 93% of the AMA-negative PBC patients, a significantly higher percentage when compared with the 66% of AMA-positive patients (p = 0.048). There were no significant differences with regard to age, sex, clinical manifestations, liver biochemistries, histological findings, survival and response to 1-year ursodeoxycholic acid treatment between the AMA-negative and AMA-positive patients. Univariate logistic regression analysis showed relatively lower serum IgM levels, positive serum ANA and anti-centromere type ANA were significant predictive factors to negative serum AMA in PBC patients (p = 0.035, 0.044 and 0.029, respectively). Multi-variate analysis revealed relatively lower serum IgM levels were the only independent significant predictor to negative serum AMA in PBC patients (p = 0.015).

CONCLUSIONS

Twenty-four percent of Chinese patients with PBC were negative for serum AMA. AMA-negative PBC patients were characterized by relatively lower serum IgM levels and a higher rate of positive serum ANA.

Primary low grade B-cell lymphoma of colon mimicking inflammatory bowel disease: a case report

Primary lymphoma of colon is rare in clinical practice and sometimes difficult to diagnose. We described a case of primary, low grade B-cell lymphoma of colon, whose clinical pictures were similar to inflammatory bowel disease. Although the colon mucosa showed diffuse infiltration of lymphocytes with lymphoepithelial lesions on endoscopic biopsy, immunohistochemical stains for B- and T-cell markers were negative. However, the diagnosis of lymphoma was established by positive findings on rearrangement of antigen receptor gene. Clinical symptom of blood-tinged diarrhea subsided after six courses of chemotherapy. Follow-up colonoscopy revealed normal colon mucosa. However, biopsy of colon mucosa still revealed mild proliferation of small lymphocytes. This case has drawn our attention that primary colonic lymphoma may clinically simulate inflammatory bowel disease, and gene rearrangement analysis might be helpful in the diagnosis of malignant lymphoma when traditional histological and immunohistochemical studies fail to provide a definite diagnosis.

Safety and immunogenicity of inactivated hepatitis A vaccine in patients with chronic liver disease

The safety and immunogenicity of inactivated hepatitis A vaccine was evaluated in patients with chronic liver disease. Sixty hepatitis A virus antibody (anti-HAV) seronegative patients with chronic liver disease (56 chronic hepatitis B and four chronic hepatitis C) and from 17 to 47 years of age received a dose of 1440 ELISA units of the inactivated hepatitis A vaccine at month 0, and a booster at month 6. Anti-HAV seroconversion (> or = 33 mIU/mL) was 57.6% (34/59) on day 15, and reached 93.2% (55/59) 1 month after primary vaccination. At month 6, the seropositivity of anti-HAV decreased before the booster to 69.0% (40/58). All vaccinees had measurable titers of anti-HAV 1 month after booster vaccination, and were still seropositive at month 12. After initial vaccination, the geometric mean titers of anti-HAV among vaccine responders were 158, 264, 74, 1309, and 409 mIU/ml at day 15 and months 1, 6, 7, and 12. Overall, 59.7% (71/119) of the vaccine doses administered were followed by mostly minor reactions. The majority of symptoms reported were local, all of which resolved within 3 days after vaccination. No significant changes in serum liver enzyme levels were detected after vaccination. Thus, an inactivated hepatitis A vaccine was safe in patients with chronic liver disease while the immune response was inferior to that observed in healthy subjects reported in a previous study.

Case report: life-threatening haematochezia from a jejunal leiomyoma

Leiomyoma is a common benign intestinal tumour. Melaena is not rare in this tumour. Recently, rectal haematochezia has been considered as one of the very rare manifestations of leiomyoma. We report a case of jejunal leiomyoma showing life-threatening rectal bleeding. This 76-year-old man was admitted to hospital because of continuous rectal bleeding for 2 days. Haemorrhagic shock occurred and transfusion of 27 units of packed red blood cells failed to correct the shock. Emergent superior mesenteric angiography revealed a distal jejunal tumour showing evidence of active oozing. Segmental intestinal resection was performed to remove this jejunal tumour. Final pathological examination disclosed a jejunal leiomyoma with a ruptured artery responsible for the life-threatening bleeding. The patient recovered after tumour resection. Our presenting case was probably the second case of jejunal leiomyoma showing haematochezia. The diagnostic priority is discussed.

Infections due to dematiaceous fungi in organ transplant recipients: case report and review

Dematiaceous fungi are being increasingly recognized as pathogens in organ transplant recipients. We describe a case of invasive esophagitis due to Cladophialophora bantiana in a small bowel transplant recipient and review a total of 34 cases of infections due to dematiaceous fungi in organ transplant recipients. The median time to the onset of fungal infection after transplantation was 22 months. Clinically, two distinct patterns of infections were observed: 79% of the patients had skin and/or soft-tissue infections or joint infections (predominantly due to Exophiala species), and 21% had systemic invasive infections (predominantly brain abscesses due to Ochroconis gallopavum [Dactylaria gallopava, Dactylaria constricta var. gallopava]). The overall mortality rate among the patients with skin and/or soft-tissue infections or joint infections and the patients with systemic invasive disease was 7% and 57%, respectively; two of five patients with brain abscesses were cured with antifungal therapy. Recognition of infections due to dematiaceous fungi is important since these infections, unlike invasive aspergillosis, may be more amenable to therapy.

Gastric emptying and gastrointestinal transit during lactation in rats

Female sex hormones can influence gastrointestinal function. To understand whether postpartum changes in female sex hormones may affect such function, gastric emptying and gastrointestinal transit were measured in rats on days 1-2, 10, 15, and 21 of lactation, on day 7 postweaning, and at the nonpregnant diestrous stage. Gastric emptying and gastrointestinal transit were assessed in conscious rats 15 min after intragastric instillation of a test meal containing charcoal and (51)Cr. The results showed that gastric emptying was increased throughout the first 2 wk of lactation, with a gradual decrease as lactation proceeded toward weaning, and returned to the level of the virgin rats by 1 wk postweaning. Gastrointestinal transit was greater in the early stage of lactation and was related to gastric emptying (P < 0.001). Increases in gastric emptying and intestinal length were correlated with lactation (P < 0.001) and plasma prolactin levels (P < 0.05) but not with plasma progesterone or estradiol levels. We concluded that the sex steroid hormones associated with lactation do not mediate a change in gastric emptying and gastrointestinal transit during lactation.

Hyperdynamic circulation in prehepatic portal hypertension: role of tumor necrosis factor-alpha

BACKGROUND

Portal hypertension is associated with a hyperdynamic circulation characterized by increased cardiac output and reduced systemic vascular resistance. Tumor necrosis factor-alpha (TNF-alpha) is a peptide mediator released by mononuclear cells on activation by endotoxin, tissue injury and malignancy. This cytokine induces vasodilatation by activating nitric oxide synthesis. The aim of this study is to investigate if TNF-alpha is involved in the pathogenesis of hyperdynamic circulation observed in portal vein-ligated (PVL) rats.

METHODS

Systemic and portal hemodynamics were determined in seven PVL and five sham-operated (SHAM) rats using a thermodilution technique. In addition, plasma TNF-alpha concentrations were determined in another 34 PVL and 16 SHAM rats using commercially available enzyme-linked immunosorbent assay.

RESULTS

PVL rats had a significantly lower mean arterial pressure (109 +/- 17 mmHg vs. 133 +/- 12 mmHg, p < 0.001) and systemic vascular resistance (2.5 +/- 0.6 mmHg.ml-1.min.100 g BW vs. 4.6 +/- 0.8 mmHg.ml-1.min.100 g BW, p < 0.001) accompanied by a significantly higher portal pressure (14 +/- 1.9 mmHg vs. 9 +/- 2.1 mmHg, p < 0.001) and cardiac index (47.0 +/- 12.1 ml.min-1.100 g BW-1 vs. 29.3 +/- 3.5 ml.min-1.100 g BW-1, p < 0.001) when compared with SHAM rats. Also, PVL rats had significantly higher plasma levels of TNF-alpha as compared with SHAM rats (13.8 +/- 0.9 pg/ ml vs. 11.1 +/- 0.5 pg/ml, p < 0.05).

CONCLUSIONS

This study suggests that elevated plasma levels of TNF-alpha observed in PVL rats may participate in the development and/or maintenance of the hyperdynamic circulation occurring in prehepatic portal hypertension.

Serodiagnosis of Helicobacter pylori infection: comparison and correlation between enzyme-linked immunosorbent assay and rapid serological test results

CLOser is a new, one-step, qualitative anti-Helicobacter pylori immunoglobulin G test having the advantage of convenience and simplicity. We aimed to evaluate its diagnostic accuracy and to compare it with a quantitative enzyme-linked immunosorbent assay (ELISA) (HEL-pTEST II) in a study of 86 adult dyspeptic patients by using the results from histology and urease testing of gastric biopsies as a "gold standard." Forty-six patients were H. pylori positive. The sensitivities, specificities, and positive and negative predictive values were 95.7, 72.5, 80.0, and 93.5%, respectively, for CLOser and 93.5, 92.5, 93.5, and 92.5%, respectively, for HEL-pTEST II. The grade of the colored test bands in CLOser was correlated with antibody titers in HEL-pTEST II (r = 0.71; p < 0.001). The mean antibody titers were 13, 74, 186, and 328 U/ml for the negative, faint, thin, and thick bands, respectively, of CLOser. We concluded that the CLOser rapid serological test yielded sensitivity similar to that of the conventional ELISA. Although CLOser is not suitable for epidemiologic screening for H. pylori infection on account of lower specificity, it is particularly convenient and very easy to perform. Therefore, it may eventually become widely used in the office-based care of patients and lead to more cost-effective patient management decisions.

Altered intestinal transit is independent of gastroparesis in the early diabetic rats

The object of this trial was to study whether deranged intestinal transit in diabetic rats should be responsible for their gastroparesis. Male Sprague-Dawley rats received i.v. injection of streptozotocin 5 days before the motility experiment. Diabetic induction led to a marked body weight loss. The rats were sacrificed 15 min after the feeding of radiochromium and charcoal contained test marker. Then the radioactivity represented gastric emptying and charcoal represented intestinal transit were counted. Diabetic induction delayed gastric emptying as compared with controls (mean +/- SE: 41.0 +/- 2.5% vs. 57.1 +/- 3.5%, p < 0.001) while the intestinal transit was also inhibited (34.2 +/- 1.4% vs. 41.5 +/- 2.7%, p < 0.05). Diabetic gastric emptying values did not exhibit any correlation with intestinal transits but a correlation with plasma glucose levels was obtained (r = 0.522, p < 0.05). Gastric emptying values almost manifested a correlation with body weight ratios during the diabetic housing (r = 0.511, p = 0.0515). We conclude that hyperglycemia is one of the mechanisms to delay liquid gastric emptying but the latter is not chiefly resulted from the deranged intestinal transit. Dysmotility is probable one of factors enabled to impair the body weight gain.

Nosocomial Legionnaires' disease caused by Legionella pneumophila serogroup 5: laboratory and epidemiologic implications

Environmental monitoring and clinical surveillance for Legionella species were done for 12 months as recommended by the Allegheny County Health Department (Pittsburgh). The water system of a hospital was found to be colonized with Legionella pneumophila serogroup 5. Three patients with nosocomial L. pneumophila serogroup 5 disease were subsequently diagnosed after laboratory tests for legionellae were made available for all patients with nosocomial pneumonia. All serogroup 5 isolates from the hospital water matched the 3 patient isolates by pulsed-field gel electrophoresis (PFGE). Furthermore, isolates found in the water supply dating back 10 years showed the same PFGE pattern. In contrast, 12 L. pneumophila serogroup 5 isolates from eight other institutions had different PFGE patterns. Routine environmental cultures were important in stimulating the application of Legionella laboratory testing, which subsequently identified unsuspected patients with nosocomial legionnaires' disease.

Assessment of enzyme immunoassay versus radioimmunoassay for detection of Legionella pneumophila serogroup 1 antigen in frozen urine specimens

An enzyme immunoassay (EIA) was compared with a radioimmunoassay (RIA) for detection of Legionella pneumophila serogroup 1 antigen in 37 frozen urine samples. Among 18 samples positive by the RIA at the time of collection, 50% (9 of 18) of stored specimens retained positivity when retested by the RIA whereas 78% (14 of 18) of stored specimens retained positivity when retested by the EIA (P < 0.02). A false-negative result occurred after storage for 5 months or less if the original RIA result showed weak positivity.

Pentoxifylline pretreatment enhances the oxidative burst activity of human peripheral blood mononuclear cells

The effect of pentoxifylline pretreatment on the lucigenin-augmented chemiluminescence and dismutase-inhibitable superoxide production of human neutrophils and mononuclear cells (MNCs) was studied. Pentoxifylline at 20-2,000 micrograms/ml enhanced the lucigenin-augmented chemiluminescence (118-165% of the control, P < 0.01) of phorbol myristate acetate (PMA)-stimulated MNC. Pentoxifylline at 20-2,000 micrograms/ml increased the MNC superoxide production, i.e., 142-171% of the control (P < 0.05) using PMA stimulation and 145-159% of the control (P < 0.01) using opsonized zymosan stimulation. In contrast, pentoxifylline (up to 2,000 micrograms/ml) did not influence the lucigenin-augmented chemiluminescence and superoxide production of human neutrophils, stimulated by either PMA or opsonized zymosan. These results suggest that pentoxifylline is an immunomodulator and may have potential usefulness in the enhancement of immune defenses in compromised hosts.

Analysis of 109 cases of infective endocarditis in a tertiary care hospital

BACKGROUND

Early diagnosis and treatment can benefit the outcome of patients with infective endocarditis. The older diagnostic criteria (von Reyn criteria) relied upon tissue pathology and blood culture results, but the sensitivity was low. A newly proposed criteria, Duke criteria which apply echocardiographic findings as a major factor in diagnosis, have shown a better sensitivity in the diagnosis of infective endocarditis.

METHODS

From 1984 to 1994, 120 episodes of endocarditis in 119 patients were reviewed retrospectively. One hundred and nine episodes fulfilling the Duke criteria were enrolled. The demographic data, antecedent disease, predisposing factors for infective endocarditis including systemic disease, prosthetic valve, intravenous drug abuse, dental or surgical manipulation, culture results, echocardiographic findings, complications and outcome were recorded and analyzed.

RESULTS

Sixty-six percent (72/109) was definite endocarditis, and 34% (37/109) was possible endocarditis, as categorized by Duke criteria. Eleven percent (12/109) of the patients were rejected by von Reyn criteria. The common possible predisposing factors were rheumatic heart disease, congenital heart disease, mitral valve prolapse, dental manipulation and intravenous drug abuse. Both patients with positive blood culture and negative blood culture results had one-fourth mortality rate. A notably higher mortality rate was found in patients with S. aureus endocarditis as compared with those of endocarditis caused by viridans streptococci(44% vs. 8%, p < 0.05). Patients with echocardiographic vegetations had a higher mortality rate (32% vs. 11%, p < 0.05) and more peripheral or organ embolic events (26% vs. 6%, p < 0.05) than those without vegetation.

CONCLUSIONS

The Duke criteria are more sensitive than the von Reyn criteria for diagnosis of infective endocarditis. S. aureus endocarditis carried a higher mortality rate than viridans streptococci endocarditis. The present study also indicated that patients with discernible valvular vegetation on echocardiogram had a high mortality rate and occurrence of peripheral or organ embolic events. However, there was no statistical significance in the development of congestive heart failure and CNS complications between the patients with and without vegetation.

Parvovirus B19 infection in a liver transplant recipient: case report and review in organ transplant recipients

We report an adult liver transplant recipient with parvovirus B19 infection, presenting as chronic transfusion-dependent anemia ensuing 1 month post-transplantation. Both serum and bone marrow cells were positive for parvovirus B19 DNA detected by polymerase chain reaction. The bone marrow biopsy revealed erythroid hypoplasia with a selective decrease of nucleated red cell precursors, and giant pronormoblasts with prominent intranuclear inclusions, characteristic of parvovirus B19 infection. Anemia and viremia resolved shortly after administration of immunoglobulin, suggesting a therapeutic role. This case and several similar ones in the literature provide justification for a controlled clinical trial of immunoglobulin for parvovirus-induced anemia in transplant recipients.

Risk factors for pancreatic cancer in orientals

In order to assess what the risk factors for patients with pancreatic cancer (PC) in Taiwan are, a retrospective study was undertaken among 282 consecutively enrolled inpatients with confirmed pancreatic cancer within the past 5 years. For comparison, 282 age- and sex-matched controls were consecutively enrolled. A history of smoking, consumption of alcohol, diabetes mellitus, cholecystectomy and gastric surgery were thoroughly reviewed. Smoking and diabetes mellitus were very common among patients with pancreatic cancer compared with controls (P < 0.01). A significant linear trend towards an increased odds ratios (OR) for the development of PC with a higher level of smoking was seen (P < 0.001). Diabetes mellitus (DM) also exhibited an increased risk (OR: 2.84; P < 0.01), while the risk still existed among those patients who had a diabetic history of more than 3 years. Among 129 histologically established PC patients, smoking remained as a risk factor for PC, while the linear trend with an increasing OR with increasing levels of smoking was confirmed again (P < 0.01). DM, particularly over the long-term, was also a risk factor for those histologically established PC patients. In summary, cigarette smoking and existing diabetes mellitus are probable risk factors for the development of pancreatic cancer in Taiwan.

An assembled electrogastrographic device to examine the meal effect on gastric slow wave

We have assembled an electrogastrographic device based on the main components of amplifiers, a band-pass filter, an analogue/digital converter, low band-pass digital filters and a personal computer. The analysis software uses autoregressive moving average modelling to compute the frequency of slow waves and uses fast Fourier transformation for power spectral computation. Twenty healthy young male volunteers were enrolled in the study to test meal-elicited responses of the slow wave. Subjects underwent a 15 min recording while fasting and then a standard breakfast, which included 250 mL milk and a cake with a total of 1.45 kj, was ingested within 5 min. The post-prandial 15 min recording was immediately resumed after the meal. A slight but significant increase in the frequency of slow waves was seen in post-prandial measurement (mean +/- s.d., 0.0506 +/- 0.0005 vs 0.0497 +/- 0.0005 Hz; P < 0.0001). Moreover, a significant enhancement of the power of slow waves was elicited following the meal (36.0 +/- 3.1 vs 27.6 +/- 3.1 dB; P < 0.0001). We conclude that this assembled electrogastrographic device is a reliable means of monitoring gastric myoelectrical activity because the phenomenon of post-prandial responses of slow waves in either frequency or power is well demonstrated.

Alteration of distal esophageal motor functions on different body positions

BACKGROUND/AIMS

This study tried to resolve whether changed body position influences esophageal manometric parameters.

MATERIAL AND METHODS

A pneumohydraulic infusion system was employed to measure esophageal parameters for 32 healthy volunteers. They underwent two consecutive manometries on both supine and sitting positions in a random order. These motility measurements included lower esophageal sphincter pressure, dry/wet swallow induced contractile amplitude and interval of distal esophageal body, and its peristaltic speed.

RESULTS

Sitting position evoked a higher lower esophageal sphincter pressure than the supine measurement (Mean +/- SD: 14.6 +/- 4.0 mmHg vs. 11.9 +/- 4.2 mmHg, p < 0.01). At the distal esophagus, a swallow led to a stronger contractile amplitude and longer interval on supine measurement.

CONCLUSIONS

Recorded peristaltic speeds in various esophageal segments resulted in a difference while this result was mainly due to the different recorded body positions (p < 0.01). Partial esophageal manometric parameters recorded on sitting position are different from the supine measurement. Hence altered body position may modulate some distal esophageal motor functions.

Characteristics of endoscopic retrograde cholangiopancreatogram in patients with primary biliary cirrhosis

BACKGROUND

The findings of cholangiopancreatograms in patients with primary biliary cirrhosis vary markedly in literature. We tried to evaluate the changes of endoscopic retrograde cholangiopancreatograms in Chinese patients with primary biliary cirrhosis.

METHODS

Twenty-nine patients with primary biliary cirrhosis underwent endoscopic retrograde cholangiopancreatography over the past 8 years. Three patients with a negative antimitochondrial antibody test were excluded. Well opacified cholangiograms and pancreatograms were obtained in 24 patients. Meanwhile, 16 subjects with normal cholangiopancreatogram served as controls. The characteristics and prevalence of abnormal cholangiopancreatograms in the patients and the correlation of radiography with clinical severity of the disease were evaluated.

RESULTS

The maximum diameters of the common bile duct (9.7 +/- 4.0 vs. 7.6 +/- 0.9 mm, NS), right (5.0 +/- 1.6 vs. 4.4 +/- 1.2 mm, NS) and left (5.1 +/- 1.2 vs. 4.9 +/- 1.4 mm, NS) intrahepatic ducts did not show significant difference between the patients with primary biliary cirrhosis and the controls. Abnormal intrahepatic cholangiograms were obtained in 12 (50%) patients including eight with diminished arborization and focal stenosis, three with crowding and tortuous branches and one with focal stenosis alone. A hepatic hilum notch on the common hepatic duct was found in eight (33.3%) patients. The abnormalities of intrahepatic ducts did not correlate with age, sex, Pugh's scores, various liver function tests or histologically cirrhotic change. One (4.2%) patient had an abnormal pancreatogram.

CONCLUSIONS

Abnormal intrahepatic cholangiograms are present in half of patients with primary biliary cirrhosis, but are not related to clinical severity.

Influence of blood glucose levels on rat liquid gastric emptying

The glycemic influence on liquid gastric emptying in rats was studied. Diabetic hyperglycemia was induced by streptozotocin-treated rats further received a daily insulin injection ( 2.5 or 10 IU/kg). Immediate hyperglycemia was induced in a separate group of rats by continuous intravenous glucose infusion (44 or 88 mg/kg/min) 10 min before the experiment. Rats were killed 15 min after radiochromium feeding; then the radioactivity of stomach and small intestine were counted to obtain the gastric emptying value. Emptying in diabetic rats was delayed compared with controls (mean +/- SE: 40.9 +/- 2.6% vs. 54.2 +/- 2.8%, P < 0.01). Low-dose insulin treatment reversed the impairment, while high-dose treatment even enhanced emptying. Immediate hyperglycemia induced with two glucose infusions also inhibited gastric emptying. Present results indicate that hyperglycemia elicited with any hyperglycemic model is at least one of the important mechanisms to delay liquid gastric emptying.

Effect of transcutaneous nerve stimulation on esophageal function in normal subjects--evidence for a somatovisceral reflex

Transcutaneous stimulation (TNS) at esophageal acupuncture points decreases lower esophageal sphincter (LES) pressures in patients with achalasia. We examined the effect of TNS on esophageal motility and vasoactive intestinal peptide (VIP) levels in normal subjects. TNS was applied to either hand or foot (placebo) in 10 volunteers. Esophageal and LES pressures were recorded and blood was drawn for VIP analysis. Hand TNS improved LES relaxation and percent of peristaltic contractions to swallows, and decreased the number of spontaneous contractions. Foot TNS decreased only spontaneous contractions while LES pressures and VIP levels were unchanged. We conclude that a somatovisceral pathway involving the esophagus exists.

The effect of cimetidine on serum acidic markers and Helicobacter pylori in gastric ulcer subjects

BACKGROUND

This study was conducted to investigate the influence of cimetidine on the Helicobacter [correction of Helilcobacter] pylori(HP) colonization and serum acidic markers in gastric ulcer patients.

METHODS

Forty-eight patients with gastric ulcer confirmed by endoscopy were consecutively enrolled. HP colonization was confirmed by either urease test or histological examination. Fasting serum gastrin and pepsinogen I (PGI) levels were measured before and after 8 weeks of cimetidine treatment.

RESULTS

Healing of ulcer at the end of treatment was 75%. Initially, the infection rate of HP was 87.5% (42/48). After 8 weeks of treatment, HP clearance rate was only 7.1% (3/42). A significant elevation of serum gastrin level was seen in HP positive subjects after treatment (86.3 +/- 22.2 pg/ml vs. 103.1 +/- 44.36 pg/ml, p <0.05) while HP negative patients did not show the effect. There was no significant change in the mean serum PGI concentration before and after cimetidine treatment (91.5 +/- 36.6 ng/ml vs. 95.6 +/- 43.8 ng/ml, NS).

CONCLUSIONS

Cimetidine is not able to clear HP despite its good efficacy in healing gastric ulcers. HP should play an important role in the elevation of serum gastrin levels during cimetidine therapy while serum PGI levels are not influenced by the antisecretory ability of cimetidine.

Hyperglycaemia is responsible for the inhibited gastrointestinal transit in the early diabetic rat

The effect of plasma glucose levels on the gastrointestinal motility of the rat was studied. Chronic hyperglycaemia was induced by i.v. injection of streptozotocin 1 week before the motility experiment. Some rats received additional daily insulin therapy (1.25, 2.5 or 10 IU kg-1) after induction of diabetes mellitus. Acute hyperglycaemia was induced by the continuous i.v. infusion of glucose solution (11, 22, 44 or 88 mg kg-1 min-1) 10 min before the motility experiments. The rats were killed 15 min after successful orogastric feeding of a charcoal-contained suspension. Gastrointestinal transit was calculated as the percentage of the overall length of the small intestine to which the charcoal moved during this time period. The diabetic rats were found to have delayed transit compared with controls (mean +/- SEM: 32.2 +/- 2.1% vs. 42.9 +/- 4.2%, P < 0.05). Correction of hyperglycaemia with moderate doses of insulin therapy failed to inhibit transit, whereas hypoglycaemia induced by high-dose insulin treatment enhanced transit. High doses of glucose elicited acute hyperglycaemia and delayed transit when compared with saline infused non-diabetic rats. In early diabetes, hyperglycaemia probably mediates the inhibited gastrointestinal transit, since correction of hyperglycaemia usually restores the delayed transit.

Pseudomelanosis duodeni: report of eight cases

Pseudomelanosis duodeni is an uncommon endoscopic sign characterized by diffuse small black spots on the first and second portions of the duodenum. It occurs predominantly in female and elderly patients and is linked to chronic illnesses and related medications. Between 1988 and 1994, the authors saw eight patients with pseudomelanosis duodeni. To evaluate the nature of the pigments, special staining was performed in seven cases. Iron stain was strongly positive in three cases. Electron microscopy was performed in two cases. This revealed amorphous bodies within macrophage lysosomes in one case and angular crystals in another case. These tests suggest that in pseudomelanosis duodeni iron metabolism may be impaired and iron is pooled within macrophages.

Influence of pregnancy and uterine weight on rat gastrointestinal transit

Orogastric feeding of a charcoal meal to rats was employed to measure whether the various stages of pregnancy could influence gastrointestinal transit. The oestrous cycle of female Sprague-Dawley rats was checked daily. If pro-oestrus occurred, the first day of pregnancy was defined to be on the next day after the copulation. Gastrointestinal transit studies were conducted on day 7 (first trimester), day 14 (second) and day 21 (third), respectively. The rats were killed 15 min after the successful feeding of a calorie-free, charcoal-containing test meal via a transiently placed orogastric catheter. Gastrointestinal transit was defined as the per cent of charcoal transit divided by the total length of the small intestine. These results were compared with the data obtained from non-pregnant female rats. Mean percentages of transit for the first, second and third trimester, and for controls were 42.8 +/- 1.9, 45.3 +/- 4.1, 35.7 +/- 1.7 and 42.6 +/- 1.4%, respectively (mean +/- s.e.). Late pregnancy elicited a marked inhibition of transit (P < 0.01). A significant negative correlation between transit and uterine weight of all pregnant rats was seen (r = -0.50, P < 0.05). The present study indicates that inhibited gastrointestinal transit occurs in the late pregnant rat.

Comparison of lansoprazole and omeprazole in the short-term management of duodenal ulcers in Taiwan

Lansoprazole is a novel H+/K+-ATPase inhibitor which exhibits a very potent and long-acting suppression of acid secretion. The object of this randomized, controlled trial was to compare duodenal ulcer healing rates after 4 weeks of treatment with a once-daily regimen of either 30 mg lansoprazole or 20 mg omeprazole. Of a total of 111 patients 57 received lansoprazole, whereas 54 received omeprazole. In intention-to-treat analysis at 4 weeks, 89.5% patients showed ulcer healing following treatment with lansoprazole compared with 83.3% of patients treated with omeprazole. Per protocol analysis indicated that 96.1% of patients treated with lansoprazole showed ulcer healing, compared with 93.6% of patients treated with omeprazole (NS). Age, smoking or ulcer size did not affect the ulcer healing rate. Both agents could effectively and quickly resolve ulcer symptoms. The Helicobacter pylori clearance was seen in 36 (73.5%) patients in the lansoprazole group and in 40 (80%) patients in the omeprazole group after four weeks of treatment (NS). In addition, both agents led to hypergastrinaemia, by approximately 1.6 fold. Adverse side effects included a few occurrences of reversible skin rash and constipation. It is concluded that lansoprazole elicits an adequate healing response and resolves symptoms of duodenal ulcer as well as omeprazole. Furthermore, lansoprazole is well tolerated with a few adverse side effects.

Respiratory burst activity of monocytes from patients with non-insulin-dependent diabetes mellitus

Monocytes from patients with poorly controlled non-insulin-dependent diabetes mellitus (NIDDM) show a decrease in intracellular bactericidal function. To determine whether this reduced bactericidal function is mediated by an impaired oxygen-dependent mechanism, we assayed the production of superoxide (O2-) and hydrogen peroxide (H2O2) by monocytes from poorly controlled NIDDM patients (n = 12), well controlled NIDDM patients (n = 12) and healthy subjects (n = 16). Using phorbol myristate acetate (PMA) as stimulant, the production of O2- by fresh monocytes was significantly decreased in poorly controlled NIDDM patients (231 +/- 30 nmol/mg protein/2-h) as compared with that of well controlled NIDDM patients (430 +/- 81 nmol/mg protein/2-h) and that of healthy subjects (399 +/- 61 nmol/mg protein/2-h), respectively (P < 0.05). Using opsonized zymosan (OZ) as stimulant, the production of O2- by fresh monocytes was also notably decreased in patients with poorly controlled NIDDM (312 +/- 42 nmol/mg protein/2-h) as compared with that of patients with well controlled NIDDM (688 +/- 92 nmol/mg protein/2-h) and that of healthy subjects (539 +/- 96 nmol/mg protein/2-h), respectively (P < 0.05). Poorly controlled NIDDM patients had a significant decrease in the production of H2O2 by monocytes, either stimulated by PMA or OZ, as compared with that of well controlled NIDDM patients and that of healthy subjects, respectively (P < 0.05). Enhancement of the production of O2- and H2O2 occurred in healthy subjects (150% increase) as well as NIDDM patients (170% increase) after a preincubation of monocytes with interferon-gamma (IFN-gamma 100 U/ml) for 48 h. The respiratory burst activity of both fresh and cultured monocytes from well controlled NIDDM patients was not significantly different from that of healthy subjects. This study suggests that both, strict metabolic control and in vitro culture with IFN-gamma may improve the monocyte oxygen-dependent bactericidal mechanism in NIDDM patients.

Decreased cell-mediated immunity in patients with non-insulin-dependent diabetes mellitus

Peripheral blood mononuclear cells from patients with non-insulin-dependent diabetes mellitus (NIDDM) show reduced proliferative response to phytohemagglutinin (PHA) and other mitogens. This study was undertaken to determine whether this reduced lymphocyte proliferation is mediated by a decreased production of cytokine or decreased expression of interleukin-2 receptor (IL-2R). Mononuclear cells from NIDDM patients (n = 34) and healthy controls (n = 22) were cultured in RPMI-1640 media containing PHA, concanavalin-A and phorbol myristate acetate. NIDDM patients showed reduced [3H]thymidine uptake (57% of controls, P < 0.01), reduced percentage of IL-2R-positive cells (61% of controls, P < 0.02) and increased level of tumor necrosis factor (TNF)-alpha (200% of controls, P < 0.05). The percentage of complement receptor (CR) 3-positive monocytes from NIDDM patients was also decreased (72% of controls, P < 0.05). However, the production of IL-1 beta, IL-2 and interferon-gamma, the percentages of pan T cells (CD3), T helper cells (CD4), T suppressor cells (CD8), the ratio of CD4/CD8 and the expression of CR1 and Fc receptors for immunoglobulin G (Fc gamma RII and Fc gamma RIII) were not significantly different between NIDDM patients and healthy subjects. Human recombinant IL-2 was unable to restore the [3H]thymidine uptake by PHA-stimulated mononuclear cells from NIDDM patients. Elevation of glucose concentration up to 27.8 mmol/l in the culture medium did not suppress the [3H]thymidine uptake and IL-2R expression by activated lymphocytes from healthy subjects. The decreased expression of IL-2R on activated lymphocytes might be responsible for the insufficient lymphocyte proliferation in NIDDM patients. These findings suggest that decreased expression of CR3 on monocytes, decreased lymphocyte proliferation and decreased IL-2R expression despite a higher production of TNF-alpha may explain the impaired cell-mediated immunity seen in NIDDM patients.

Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens

A retrospective study on patients with pyogenic liver abscesses was conducted to clarify the different clinical presentations among patients with Klebsiella pneumoniae abscesses and those with non-K. pneumoniae abscesses. From 1981 to 1993, the medical records of 146 adults with culture-confirmed pyogenic liver abscesses who attended Tri-Service General Hospital in Taipei were studied. Abscesses due to K. pneumoniae accounted for 114 (78%) of pyogenic liver abscesses. When compared to patients with non-K. pneumoniae abscesses, patients with K. pneumoniae liver abscesses had significantly higher proportions of monomicrobial infections, unknown sources of infection and solitary abscesses. Patients with K. pneumoniae liver abscesses were found to have diabetes mellitus more often than patients with non-K. pneumoniae liver abscesses (66% vs 19%). Septicemia was found more frequently in patients with K. pneumoniae liver abscesses than in patients with non-K. pneumoniae liver abscesses (50% vs 27%). The clinical presentations among the two groups were, otherwise, not significantly different. Regardless of the microbial etiology, patients with diabetes mellitus had longer periods of fever after treatment and hospitalization than patients without diabetes. The reason for the high relative frequency of liver abscesses in Taiwan and its more frequent occurrence in diabetes mellitus remains unclear.

A biopsy urease test in the detection of Helicobacter pylori: comparison of antral and body specimens

BACKGROUND

This study was to compare the difference of positive rate and reaction time between the antrum and the body specimens in duodenal ulcer (n = 124) and non-duodenal ulcer (n = 181) patients.

METHODS

A total of 305 subjects with positive urease test were evaluated. During endoscopy each biopsy specimen from the greater curvature side of the antrum and the body was immediately incubated in a thermostatically controlled 37 degrees C waterbath and examined regularly in the first 6 h, and if there was no response, reexamined after 24 hours. A change from orange to pinkish red was considered positive.

RESULTS

There was no difference in the positive rate of urease test between the antrum and the body in patients with duodenal ulcer (95.2% vs. 94.4%); whereas, the positive rate was higher in the body specimens than in the antral specimens in patients without duodenal ulcer (p < 0.05, 97.8% vs. 89%). Antral specimens had more rapid color change of urease test than the body specimens patients with duodenal ulcer; whereas no such difference was found in patients without duodenal ulcer. In the antral specimens of patients without duodenal ulcer who were less than 60 years old, the color change was more rapid than in those older than 60 (median 1.0 hr vs. 1.5 hr, p < 0.05).

CONCLUSIONS

For better detection of H. pylori colonization using a urease test, it is critical to choose a suitable biopsy site. In non-duodenal ulcer disease, biopsy of the greater curve of the body has a higher detection rate than that of the antrum. In duodenal ulcer disease, biopsy of the antrum is better than that of the body for its quicker reaction.

Triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse: comparison of 1 week and 2 week regimens and recrudescence rates over 12 months

The aim of this study is to assess the relationship between Helicobacter pylori and the relapse of duodenal ulcer, and also to evaluate the differences in efficacy and side effects between 1 week and 2 week triple therapy. Sixty-two patients with active duodenal ulcer, which healed within 8 weeks of nizatidine treatment, were randomly allocated to one of two groups. Group 1 (n = 29) received no drugs, Group II (n = 33) received triple therapy for 1 week (IIa, n = 16) or 2 weeks (IIb, n = 17). Eleven patients whose ulcer did not heal after an 8 week nizatidine treatment period were randomly assigned into Group IIa (n = 5) and IIb (n = 6). Seven patients whose ulcer recurred after discontinuation of nizatidine were allocated to receive 2 weeks of triple therapy. All patients received endoscopy 6 weeks after entry, and again at 3, 6 and 12 months unless both ulcer recurrence and H. pylori infection were found. The frequency of ulcer relapse 6 weeks after the active duodenal ulcer had healed was 83% (24/29 in Group I, 13% in Group 11a and 14% in Group IIb. The cumulative rate of recurrence was significantly higher in Group I than in Group II (90 vs 30% at 12 months, P < 0.01). Ulcer relapse was associated with persistence of H. pylori infection (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

A single standard nocturnal dose of nizatidine enhances the healing of active duodenal ulcers among Chinese

Chinese people have a lower maximal acid output and gastrin response to meals compared to Western people. The aim of the present study was to assess the efficacy of a half-single nocturnal dose of nizatidine (150 mg at bedtime [h.s.], n = 40) with a standard full dose given once nightly (300 mg h.s., n = 38) or twice daily (150 mg twice a day [b.i.d.], n = 43) in the treatment of Chinese patients with active duodenal ulcers. An endoscopy was performed upon entry and at 4 week intervals until the ulcer healed (up to 8 weeks). There is no statistical difference in healing rates after 4 weeks of treatment (52.5, 52 and 47% in nizatidine 150 mg h.s., 150 mg b.i.d. and nizatidine 300 mg h.s., respectively) whereas nizatidine 300 h.s. had a significantly higher healing rate compared to nizatidine 150 mg h.s. and b.i.d. after 8 weeks of treatment (89 vs 70 and 67%, P < 0.05) by uni- and multivariate analysis of clinical and endoscopic characteristics. Symptomatic response was not significantly different in these three treated groups. Our study suggested that a half-single nocturnal dose of nizatidine is not ideal for the treatment of duodenal ulcer in Chinese patients, whereas a single standard nocturnal dose appears more effective than a twice-daily regimen.

A randomized study comparing glucagon and hyoscine N-butyl bromide before endoscopic retrograde cholangiopancreatography

BACKGROUND

This study tried to resolve whether glucagon is a better premedication for endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

We first measured the basal blood sugar and amylase levels. Then an endoscope was placed in the duodenum without premedication, and basal pulse and duodenal peristaltic rates were measured. ERCP began after studied subjects were randomly premedicated with either 1 mg glucagon (n = 38) or 40 mg hyoscine N-butyl bromide (n = 36) intravenously. Ten minutes later the variables were measured again.

RESULTS

Glucagon elicited hyperglycemia whereas hyoscine N-butyl bromide manifested an anticholinergic effect. No difference was found between these two groups with regard to the necessary interval for ERCP (20.6 +/- 14.1 min versus 21.4 +/- 14.7 min; NS) or the success rate for cholangiopancreatography (92.1% versus 91.7%; NS). Neither hyperamylasemia nor pancreatitis was preventable when glucagon was used.

CONCLUSIONS

The two premedications appear equally effective in the performance of ERCP.

Effects of sex steroid hormones on gastric emptying and gastrointestinal transit in rats

In vitro studies have shown that estrogen and progesterone can affect the contractile response and myoelectric activity of the gastrointestinal smooth muscle. The present study was designed to investigate the effect of sex steroid hormones on gastric emptying and gastrointestinal transit were assessed in rats 15 min after intragastric instillation of a test meal containing charcoal and 51Cr. Gastric emptying was determined by measuring the amount of labeled chromium contained in the small intestine as a percentage of the initial amount received. Gastrointestinal transit was evaluated by calculating both the geometric center of distribution of the radiolabeled marker and the charcoal transit in the intestine. The experimental animals included diestrus rats; ovariectomized rats treated with vehicle, estradiol, and/or progesterone; and normal male and orchiectomized rats treated with vehicle or testosterone. Female rats in diestrus had a slower gastric emptying and a lesser geometric center value than ovariectomized rats. Estradiol inhibited gastric emptying but did not affect gastrointestinal transit. Progesterone increased gastric emptying. Progesterone at lower dose (10 mg/kg) decreased the geometric center compared with higher doses (20 or 40 mg/kg) or vehicle controls. A mixture of estradiol (10 micrograms/kg) and progesterone (20 mg/kg) inhibited gastric emptying to a similar degree as estradiol (10 micrograms/kg) did. Testosterone had no influence on gastric emptying or gastrointestinal transit. These results suggest that estradiol and a mixture of estradiol and progesterone inhibit, whereas progesterone enhances, gastric emptying. Testosterone did not play a role in gastrointestinal motility.

Gastric inhibitory polypeptide and gastric acid secretion in pregnant rats

The effects of pregnancy on the basal and pentagastrin-stimulated gastric acid secretion and the level of plasma gastric inhibitory polypeptide (GIP) in rats were studied on pentobarbital-anaesthetized non-pregnant rats and rats in the 1st, 2nd, or 3rd week of gestation. Acid output was determined by titration of the gastric perfusate. Basal secretion was collected for 45 min before a 30 min infusion of pentagastrin (8 micrograms/ml/300 g body weight). Concentration of plasma GIP was measured by a radioimmunoassay (RIA). The immunoreactivity of GIP-like substance in the extract of the rat placenta collected from the rat at day 21 of gestation was examined by RIA. The biological activity of GIP-like substance in the rat placenta extract was tested by the reduction of pentagastrin-stimulated gastric acid secretion in male rats. The basal level of gastric secretion was higher in late pregnancy as compared with the non-pregnant rats. Pentagastrin induced a greater increase of gastric acid secretion in early but not late pregnant rats as compared with the non-pregnant animals. The basal and post-pentagastrin level of plasma GIP was higher in rats in late pregnancy. Both immunoreactivity and biological activity of GIP exist in the rat placenta extract. These results suggest that the normalization of gastric acid secretion in late pregnant rats is at least in part due to the production of GIP-like substance from placenta.

Oesophageal perforation following endoscopic variceal ligation and balloon tamponade

Endoscopic variceal ligation (EVL) related complication is rarely reported. A case is presented of a 74 year old man with oesophageal variceal bleeding who developed oesophageal perforation following EVL and balloon tamponade. An oesophageal wall defect was induced by EVL and tissue repair was hindered by decompensated liver reserve and shock status; concomitant balloon tamponade precipitated oesophageal perforation. The case is reported to draw attention to oesophageal perforation after concurrent use of balloon tamponade and EVL.

Effect of eradication of Helicobacter pylori on serum pepsinogen I, gastrin, and insulin in duodenal ulcer patients: a 12-month follow-up study

OBJECTIVES

To understand the short-term and long-term effects of the eradication of Helicobacter pylori on serum pepsinogen I, gastrin, and insulin concentration, we studied 53 patients with endoscopically proven duodenal ulceration and H. pylori infection.

METHODS

All patients received a 2-wk course of colloidal bismuth subcitrate, amoxycillin, and metronidazole, and endoscopy was performed at 1.5, 3, 6, and 12 months after entry. H. pylori status was assessed by a urease test and histology.

RESULTS

Among 43 patients in whom H. pylori was eradicated throughout the follow-up year, the mean basal pepsinogen I was 108 ng/ml at pretreatment, decreasing significantly to 85, 77, 80, and 75 ng/ml at 1.5, 3, 6, and 12 months, respectively, at posttreatment. The basal gastrin was 100 pg/ml at pretreatment and fell significantly to 72, 64, 65, and 59 pg/ml, respectively, posttreatment. Of the four patients in whom the H. pylori was not eradicated, there was no significant change in the median basal pepsinogen I and gastrin concentration. Among the six patients in whom the H. pylori was again detectable within the follow-up year, the fallen serum concentration of pepsinogen I and gastrin returned to the pretreatment level. There was no significant change of basal insulin concentration after triple therapy in either the successfully eradicated or failed group.

CONCLUSION

We conclude that H. pylori is the leading and direct cause of higher serum concentration of pepsinogen I and gastrin in duodenal ulcer patients.

Comparison of two orogastric feeding markers for measuring gastrointestinal motor functions in rats

Rat gastrointestinal (GI) transit parameters measured with charcoal and radiochromium were compared. Animals were fed with a calorie-free liquid test meal which contained 10% charcoal and radiochromium (0.5 microCi ml-1) via a transiently placed orogastric catheter. The rats were sacrificed at 1, 5, 15, 30, 60 and 120 min, respectively, since feeding. Various motor parameters were measured. Charcoal transit ratio, gastric emptying and geometric center were time dependent. Charcoal transit ratio occasionally showed a positive correlation with gastric emptying in the very late experimental periods. Concerning the correlation of charcoal transit ratio and geometric center, negative and positive correlations were seen in the very early and late periods, respectively. We conclude that the rat charcoal transit ratio has limited value to replace the GI transit parameters determined by feeding radiochromium.

Coexistent duodenal ulcer among patients with gastric carcinoma

To examine the prevalence of coexistent duodenal ulcers among patients with gastric carcinoma in an otherwise intact stomach, we surveyed 604 endoscopically and pathologically diagnosed gastric carcinoma patients and thoroughly inspected their duodenums. Twenty-two (3.6%) of them had either active ulcers or scars in the duodenum. This prevalence was significantly less than that among 99 (16.4%) of 604 age- and gender-matched controls with endoscopically confirmed duodenal ulcers (P < 0.0001). Almost one-half of patients with coexistent cancer and duodenal ulcer experienced no change in abdominal symptoms when gastric cancer was diagnosed. Barium meal study appeared not to be sensitive enough to diagnose the coexistent ulcers. However, the nature of the lesions, including disease location, macroscopic appearance, chance of early cancer and metastasis, was no different in 22 patients with coexistent cancer and duodenal ulcer than in 582 patients with cancer alone. The present study suggests that although duodenal ulcer is unlikely to be a predisposing factor for gastric cancer, thorough screening by means of endoscopy is necessary in dyspepsic ulcer patients since duodenal ulcer and gastric cancer are not incompatible.

[Seroprevalence of human immunodeficiency virus infection in Guinea-Bissau, west Africa]

The seroprevalence of human immunodeficiency virus (HIV) infection in Guinea-Bissau, West Africa, was determined by enzyme-linked immunosorbent assay (ELISA). From January 1987 to February 1993, 590 patients from the outpatient and inpatient departments of Regional Hospital at Canchungo, Cacheu, Guinea-Bissau were studied. The overall seropositive rate was 16%. Patients in the age between 25 and 54 accounted for 78% of HIV-positive cases. The seropositive rate according to the diagnosis was: 6% in pregnant women, 40% in patients with gonorrhea/syphilis, 14% in patients with vaginitis and 22% in patients with active pulmonary tuberculosis. The seropositivity for HIV-1/2 in the pregnant women might reflect the seroprevalence in general population of Guinea-Bissau. Accordingly, the estimated population infected by HIV would be sixty thousands in Guinea-Bissau. Both sexually-transmitted diseases and tuberculosis were the risk factors for HIV infection. This study shows that HIV infection is a critical problem of public health in Guinea-Bissau. Strategies to prevent the seeding of HIV are of great importance. Moreover, the members of medical mission from our country must keep alert for preventing HIV infection.

Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect?

Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomized to receive endoscopic injection therapy with either 1:10,000 epinephrine in water (Group I) or distilled water (Group II). Twenty-five out of 27 patients in group I, versus 22 out of 25 patients in group II, achieved initial hemostasis after endoscopic injection therapy (p > 0.05). Five patients who did not respond to local injection had bleeding controlled by heater probe thermocoagulation or surgical intervention. Three patients in each group developed rebleeding after initial hemostasis. Four of these patients had bleeding controlled by surgical intervention, while the other two died of underlying diseases. No change in systemic blood pressure, but a significant drop in the pulse rate were noted in both groups after injection therapy. Patients with shock at admission or ulcer size greater than 2 cm had a significantly higher rebleeding rate after initial hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05). No serious complications were observed after injection therapy, and no significant difference in the amounts of solution required for successful hemostasis was noted between the two groups. We conclude that a local tamponade with distilled water is as effective and safe as diluted epinephrine solution for endoscopic injection therapy.

The changes of serum acidic markers in human subjects receiving pharmacological dosage of antispasmodics

BACKGROUND

Anticholinergic and glucagon result in the diminished gastric acid secretion, it is unknown whether these agents may again influence serum acidic markers.

METHODS

The changes of serum levels of acidic markers represented with gastrin and pepsinogen I at 10 min after the injection of either hyoscine-N-butyl-bromide (HNBB) 20 mg (n = 31) or glucagon 1 mg (n = 32) were investigated when these subjects were receiving endoscopic retrograde cholangiopancreatography for various reasons.

RESULTS

At this period, both medications exerted an antispasmodic action on the duodenum. An anticholinergic effect was seen only among the HNBB group, whereas hyperglycemia appeared among the glucagon group. HNBB did significantly inhibit serum pepsinogen I levels when compared with their basal levels (mean +/- SD: 92.1 +/- 33.2 ng/ml vs. 83.2 +/- 27.4 ng/ml, P < 0.01). However, HNBB did not influence serum gastrin levels. Glucagon inhibited both serum pepsinogen I (89.1 +/- 39.7 ng/ml vs. 80.5 +/- 37.4 ng/ml, P < 0.005) and gastrin (79.3 +/- 31.3 pg/ml vs. 71.3 +/- 23.8 pg/ml, P < 0.01) levels compared with their basal levels.

CONCLUSIONS

Present observations indicate that glucagon and HNBB may inhibit serum PGI level, whereas the former has the additional effect of inhibiting serum gastrin level.

Septicemia caused by Vibrio parahemolyticus: a case report

Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.

Serodiagnosis of tuberculosis using the A60 IgG ELISA

The serodiagnosis of tuberculosis (TB) by using an enzyme-linked immunosorbent assay (ELISA) to detect IgG against mycobacterial antigen 60 (A60) was evaluated. Forty-three controls (10 healthy adults, 19 patients with non-tuberculous pulmonary diseases and 14 patients with non-pulmonary infectious diseases) and 63 patients with TB in different disease activity (50 patients with active TB and 13 patients with old pulmonary TB) were studied. When a cut-off value of 200 units was selected, the results obtained with controls were: 100% negative in IgG titers in healthy adults and patients with non-pulmonary infectious diseases, 89% negative in IgG titers in patients with non-tuberculous pulmonary diseases. The overall "false positive" rate was 5% in the control groups. The percentage of serologically positive cases of active TB was: 82% in smear-positive, 67% in smear-negative/culture-positive and 38% in culture-negative. Of the 13 patients with calcified pulmonary TB, four had a positive serological response (31%). Four out of eight patients with active TB showed an elevation in IgG titer 1 to 3 months after diagnosis and anti-TB chemotherapy. The positive and negative predictive values of the test may provide valuable information according to the prevalence of TB in different populations. When the TB prevalence is high, a positive IgG ELISA test may support the diagnosis of active TB.