Efficacy of one week triple therapy with amoxicillin (1,500mg/day) , clarithromycin (800mg/day) , and lansoprazole (60mg/day) or omeprazole (40mg/day) for 61 patients with Helicobacter pylori infection was investigated. Diagnosis of H pylori infection was based on the result of rapid urease test, and eradication of H pylori was assessed by culture and Giemsa staining of antral as well as corporeal biopsy specimens 6-8 weeks after the cessation of the eradication therapy. Three patients were dropped out from the therapy due to side effects, such as diarrhea or urticaria. H pylori eradication was observed in 28/36 (78%) in patients with gastric ulcer, 16/17 (94%) with duodenal ulcer, and 5/5 (100%) with chronic gastritis. Overall eradication rate was 49/84 (84%) . Lansoprazole has been reported to be about 4 times stronger against H pylori than omeprazole in vitro, however in the present study eradication rate with lansoprazole and omeprazole were similar (82% vs 89%) . Recurrence of gastric ulcer was observed in a patient after success of eradication of H pylori, and the reasons of ulcer recurrence were smoker and night worker. A week triple therapy with amoxicillin, clarithromycin, and proton pump inhibitor was considered to be promising with good compliance.
We report a case of massive pulmonary hemorrhage which emerged in the course of polyarteritis nodosa (PN). Pulmonary hemorrhage was the major manifestation which determined the mortality of this patient, though severe renal failure concurrently developed. The diagnosis of PN should be considered in all cases of pulmonary hemorrhage coexisting with renal failure. As pulmonary hemorrhage can be life-threatening, early diagnosis is essential for the prompt start of adequate therapy.
In patients with hepatocellular carcinoma (HCC), recurrences in the distant liver often are observed after curative treatment. Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have been developed as less invasive alternatives than surgical resection for small HCCs. In the current study, risk factors for distant recurrence of HCC were analyzed in patients in whom complete coagulation was achieved.Ninety-two patients with HCCs < 3 cm in greatest dimension were treated by MCT or RFA percutaneously or laparoscopically. Eighty-four patients in whom complete coagulation was achieved without recurrence in the same subsegment as the primary nodule were included in this study. Distant recurrences were observed in 22 patients. Fifteen possible risk factors for a distant recurrence were analyzed.When comparing the patients with a recurrence of HCC nodules in the remnant liver to those without recurrence, the authors observed a statistically significant difference only in serum alpha-fetoprotein. The distant recurrence-free survival was analyzed by the Kaplan-Meier method. A statistically significant difference was observed in hepatitis C virus (HCV) infection as an etiopathic agent of underlying liver diseases (P < 0.005) and in the number of the primary HCC nodules (P < 0.05, log-rank test). A multivariate stepwise Cox hazard model revealed that HCV infection and the number of primary HCC nodules were statistically independent risk factors.Patients who had more than two HCC nodules accompanied by HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or ablation by radiofrequency was complete.
Two sisters were presented, 16 years old and 12 years old, who showed similar clinical courses. They had had mental retardation since early childhood, and then ataxia began. They suffered from astatic and tonic seizures from early school age, which gradually evolved to intractable epilepsies. Spasticity progressed, and they deteriorated both physically and mentally. They revealed photo-sensitivity; convulsions were induced by the flickering of light. They were attacked by myoclonic seizures as well as choreoathetosis, and became bedridden by the latter part of the elementary school age. There were no fruitful results of any kind from the laboratory examinations for metabolic disorders. EEG showed that the epileptic seizure discharges were induced by photic stimulation; there were frequent 3-4 Hz diffuse spike-and-wave short bursts during waking and sleep periods. MRI findings of the elder sister at the age of 16 revealed remarkable diffuse brain atrophy. Gene analysis showed abnormally enlarged DNA fragments localized on the short arm of chromosome 12. This meant expanded CAG trinucleotide repeats. The younger sister died at the age of 12 years. Autopsy findings revealed degeneration of both dentatorubral and pallidoluysian pathways. There were especially remarkable gliosis and neuronal cell loss in the outer segment of globus pallidus, and moderate neuronal cell loss and typical grumose degeneration in the dentate nucleus. The diagnosis of juvenile-type hereditary dentatorubral-pallidoluysian atrophy was compatible with the pathologic findings. This diagnosis will be made possible before death through the understanding of the clinical symptoms and molecular genetics.
Nitric oxide (NO) is formed in small amounts in vivo and is rapidly oxidized by interacting with oxygen, making measurement of its level difficult. The chemiluminescence assay is the most widely used method for detecting NO and is extremely sensitive to very small amounts of NO. However, it is difficult to prepare small amounts of NO to be used as a standard for NO analysis. NOR-1, a derivative of NOR-3, is a newly discovered NO donor with rapid NO-releasing activity. We assessed the dynamics of NO release and decomposition using NOR-1. Our results demonstrate that NOR-1 is stable in dimethylsulfoxide (DMSO) and is able to dilute at lower concentration (to picomolar levels) by DMSO without decomposition. NOR-1 released persistently 1.4 more excess of NO with 15 min of incubation. There was a linear relationship between the concentration of NOR-1 and that of NO released from NOR-1 (r=0.997) These findings suggest that NOR-1 is a useful reagent for the calibration of lower NO detection.
An 85-year-old woman was admitted with massive upper gastrointestinal hemorrhage. She had a history of small upper gastrointestinal bleeding on 11 days before admission. On admission, physical examination revealed a pulsatile abdominal mass and her hematocrit was 16.8 per cent. An emergency endoscopic examination revealed no bleeding source in the esophagus and stomach but bleeding from pulsatile submucosal elevation at the third portion of the duodenum. A CT scan demonstrated a 6-cm abdominal aortic aneurysm. Emergency laparotomy revealed an abdominal aortic aneurysm with aortoduodenal fistula at the level of third portion. The fistula was taken down and closed, and the aneurysm was replaced by a graft. Histology of the resected aorta showed the features of atherosclerotic aneurysm with fibrin plug at the fistula. No complication including infection and rebleeding occurred, and endoscopy at 14 days after surgery revealed improvement of the duodenal fistula. Aortoduodenal fistula is rare but invariably fatal without precise diagnosis and prompt surgical treatment. The presence of antecedent nonexsanguinating hemorrhage before hypovolemic shock, socalled“herald bleed”is present in two-thirds of the patients, making it important to establish diagnosis before fatal exsanguination. Physician should consider the diagnosis of aortoduodenal fistula in patients with even mild upper gastrointestinal bleeding of uncertain etiology and abdominal pulsatile mass.
