Five-day proton pump inhibitor-based quadruple therapy regimen is more effective than 7-day triple therapy regimen for Helicobacter pylori infection.

BACKGROUND: There have been no reports that describe whether 5-day quadruple therapy (rabeprazole + amoxicillin + clarithromycin + metronidazole; RACM) could substitute for standard 7-day triple therapy as a first-line therapy for Helicobacter pylori. PATIENTS AND METHODS: This study was designed as a randomized prospective single centre study. A total of 160 H. pylori-positive patients who had not received therapy were given either a 5-day RACM regimen (n=80, rabeprazole 20 mg b.d., amoxicillin 750 mg b.d., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d.) or a 7-day RAC regimen (n=80, rabeprazole 20 mg b.d., amoxicillin 750 mg b.d. and clarithromycin 200 mg b.d.). Cure of the infection was assessed by a (13)C urea breath test 1 month after the completion of therapy. RESULTS: The eradication rates of the 5-day RACM regimen and the 7-day RAC regimen were 93% (95% CI: 84--97%) and 81% (95% CI: 71--89%) by intention-to-treat analysis, 94% (95% CI: 86--98%) and 83% (95% CI: 73--91%) by all-patients-treated analysis analysis and 95% (95% CI: 87--98%; P < 0.05) and 82% (95% CI: 72--90%) by per protocol analysis, respectively. No serious adverse effect was observed, and 99% of the patients reported complete compliance. CONCLUSIONS: The cure rate of the 5-day RACM regimen was more effective than the 7-day RAC regimen, suggesting that this regimen could be preferable as a first-line therapy for H. pylori infection.

Intramuscular (15S)-15-methyl prostaglandin F2alpha for midtrimester and missed abortions.

The efficacy of intramuscular 15-me-PGF2alpha as an abortifacient was evaluated in 40 women between 14 and 20 weeks of gestation and 6 patients with missed abortions. Pregnancy was successfully terminated in all the cases. The injection-abortion interval was significantly lower in 20 patients (Group II) who had intracervical laminaria insertion prior to treatment with 15-me-PGF2alpha than in 10 women (Group I) without laminaria insertion (t = 7.2; P less than .001). Abortion was also accomplished in 10 women with ruptured membranes and 6 patients with missed abortions. Gastrointestinal side effects were minimal and acceptable when premedication with antiemetics and an antidiarrheal was used. This study demonstrates the availability of the intramuscular route--a simple, safe, reliable means of terminating pregnancy, especially during the early midtrimester period.

Successful manual reduction of locked metacarpophalangeal joints in fingers.

BACKGROUND: Many studies on the etiology and operative treatment of locked metacarpophalangeal joints in fingers have been reported, but there have been few investigations on manual reduction. The rate of success of manual reduction in previous reports has been low, and no consensus has been reached with regard to the best method of manual reduction. On the basis of our experience with operative treatment, we devised a safe method of manual reduction. METHODS: Between January 1987 and December 1995, we reduced a locked metacarpophalangeal joint in twelve female patients; every locked finger was successfully reduced, and complications such as fracture did not occur during manual reduction. The average duration of follow-up was five years and nine months (range, three years and two months to nine years and three months). RESULTS: Six patients had no recurrence of the locking. Four of the six remaining patients had one or two incidents of locking, had no alteration in the activities of daily living, and did not want operative treatment. The two remaining patients reported that they had incidents of locking several times a day, and they requested operative treatment as they were afraid of additional recurrences. One patient had an open reduction fifteen months after the initial episode of locking, and the other patient elected not to have an operation for personal reasons. CONCLUSIONS: We believe that our method of manual reduction should be used to treat a locked metacarpophalangeal joint in a finger and that operative treatment should be limited to patients in whom manual reduction is unsuccessful or the reduction is unstable.

[Two cases of the epidermoid on the petrous bone].

Epidermoids known as cholesteatomas, are congenital benign tumors and originate in the embryonic ectoderm. They account for 1.3% of all intracranial tumors. They are often found in the cerebellopontine angle and the paraseller region, but rarely in the petrous portion of the temporal bone. Epidermoids of the petrous bone tend to slowly present progressive facial palsy and hearing disturbance. In this article, two cases of epidermoids involving the petrous bone are reported. A 55-year-old male presented left facial palsy, left hearing disturbance and decreased gustation in the left side of the tongue. MRI revealed a non-enhanced mass on the petrous portion of the left temporal bone, and bone-window CT showed bone destruction in the same region (Case 1). A 71-year-old female was aware of left facial palsy and left hearing loss for 15 years. MRI showed a non-enhanced mass on the petrous bone, and bone-window CT demonstrated extensive bone erosion of the petrous bone and the middle cranial fossa (Case 2). In both cases, total removal was performed via the middle cranial fossa approach. Both tumors existed extradurally and had pressed against the genicurate ganglion of the facial nerve. The facial palsy of the former case recovered 12 months after surgery. We discuss the problems of diagnosis and treatment of epidermoids of the petrous bone.

[Fenestrated basilar artery aneurysm: case report].

The authors reported an operated case with an aneurysm arising from the proximal end of basilar artery fenestration, and discussed its etiology and surgical strategy. A 47-year-old woman presented with slight memory disturbance. Neuroradiologic examination revealed an aneurysm located on the proximal end of the basilar artery 12 x 9 mm in size at the level of the outer auditory meatus. The union of vertebral arteries had deviated toward the right side, and the aneurysmal dome had projected into the fenestration. Through the right far lateral approach, we applied two straight fenestrated clips X configuration to the aneurysm. Several authors have reported a variety of approaches for vertebrobasilar aneurysms along the midline with consideration of the height of the aneurysmal. However, another point of view is that attention should be paid to the direction of the clip blade and applied at the final clipping, because, for vertebrobasilar aneurysms adjacent to the midline, the surgical view and working space are extremely restricted.

[Development of the role of occupational health nursing in the U.S. and future perspectives in the U.S. and Japan].

Occupational Health Nursing in the United States has developed a solid foundation for a century, and is one of the pioneering countries which have the most advanced occupational health nursing practices in the world. The purpose of this study is, by reviewing the literature, 1) to overview the history of role development in occupational health nursing in the U.S., 2) to identify several factors affecting it, and 3) to discuss the occupational health nursing roles in the future on the U.S. as well as in Japan. There are three periods in the history of the role development of occupational health nursing in the U.S. I. 1890s-1920s: the Emergence of Occupational Health Nursing; Ada Mayo Stewart, the first occupational health nurse in the U.S., was employed by Vermont Marble Company in 1895, and worked as a clinician to provide the emergency care for work related injuries as well as working a primary nurse to visit the homes of the employees and their families for health education. II. 1930s-1950s: The Development of Standards of Nursing Practices; Occupational health nurses were committed to the early detection and prevention of work/non-work related diseases and illnesses as well as direct care. The American Association of Industrial Nurses (AAIN), the nationwide professional organization for the industrial nurses, was established in 1942. The AAIN developed standards of industrial nursing practices which formed the basis of the current standards of occupational health nursing practices; III. 1960s-: Occupational Health Nurses working as Nurse Specialists; Since the 1960s, many health hazards related to workplace exposure and working conditions had resulted in illness and injuries, and had become a social problems. The federal government legally obligated employers to promote workers' safety and health. Employers sought the services of occupational health nurses who has special knowledge and skills to improve health and safety in workplaces. In 1972, the AAIN started the program of the Certified Occupational Health Nurses. In the 1970s, several universities established the programs of occupational health nursing at the master level. With the impacts of these legal and social changes, the occupational health nurses have been evolving and developing advanced nursing practices. The current five basic roles of the occupational health nurses are: clinician, administrator, educator, consultant and researcher. In conclusion, the occupational health nurses in the U.S. started their practices as clinicians, and have been developing their advanced nursing practices which require professional knowledge and skills. As in the U.S., occupational health nurses in Japan should develop their roles as specialists in occupational safety and health.

[Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism in three patients with systemic lupus erythematosus and antiphospholipid syndrome].

Pulmonary hypertension (PH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Several potential mechanisms have been postulated for narrowing of vessels as a result of pulmonary vasculitis and pulmonary thromboembolism caused by antiphospholipid antibodies. Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism is performed to alleviate pulmonary hypertension. We report three rare cases of SLE with antiphospholipid syndrome in patients who presented with PH secondary to chronic pulmonary thromboembolism. Pulmonary thromboendarterectomy was performed, and all patients remained well without deterioration of PH after surgery. Pulmonary thromboendarterectomy should be considered as an effective method of treatment for this disease.

[Efficacy of intrahepatic arterial chemotherapy to prevent recurrence of residual liver in metastatic liver cancer patients after hepatectomy].

Five-year overall survival rates in 17 cases who underwent the hepatectomy for metastatic liver cancer from digestive tract averaged 43%. Postoperative intrahepatic arterial infusion in combination with Farmorubicin and 5-FU was performed in 9 cases (i.a group). Survival and recurrence rate on cases (i.a group) were compared with that of 8 cases without chemotherapy (control group). The 5-year survival rate was superior in the i.a group to that in the control group. There was no residual liver recurrence in the i.a group, but two cases had recurrence in the residual liver in the control group. These results suggest that the post-hepatectomized intrahepatic arterial infusion of anticancer drugs is useful to prevent recurrence in the residual liver and may prolong the survival time of patients with metastatic liver cancer from GI tract.

Quantitative evaluation of anterior tibial translation during isokinetic motion in knees with anterior cruciate ligament reconstruction using either patellar or hamstring tendon grafts.

We studied 79 patients with unilateral injury to the anterior cruciate ligament (ACL). The patients were randomly allocated to reconstruction with autologous patellar bone-tendon-bone (BTB) grafts (49 knees) or hamstring tendon (ST) grafts (30 knees). We measured anterior tibial translation (ATT) during isokinetic concentric contraction exercise 18-20 months after surgery using a computerized electrogoniometer. In both groups the highest ATT during exercise was observed at a knee flexion of about 20 degrees and was 13.5+/-3.0 mm in the BTB group and 13.9+/-3.4 mm in the ST group. There was no difference in the ATT between the reconstructed and healthy knees. For a range of knee flexion between 30 and 50 degrees the ATT in the ST group was significantly higher on the reconstructed side than on the healthy side. In the BTB group, the mean ATT in the reconstructed group was similar to that on the healthy side at a knee flexion angle between 0 and 90 degrees .

[Autologous vs bovine pericardial valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot].

Autologous or glutaraldehyde treated bovine pericardial valved patch was utilized for widening of the right ventricular outflow tract in 20 patients with tetralogy of Fallot (autologous pericardium group in 10 patients and bovine pericardium group in 10). Pericardial valve function of the both materials was evaluated by postoperative cardiac catheterization performed 1 year after the operation. There were no significant differences in pulmonary arterial and right ventricular pressures, and right ventricular ejection fraction and end-diastolic volume between the 2 groups. Pulmonary angiogram in the autologous pericardium group patients demonstrated the pulmonary regurgitation (PR) of grade 1 in 5 patients, grade 2 in 4 and grade 3 in 1. On the other hand, 1, 3 and 6 patients in the bovine pericardium group demonstrated no-PR, grade 1 PR and grade 2 PR, respectively. It was concluded that there were no significant differences between autologous and glutaraldehyde treated bovine pericardium as a material of valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot.

Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis.

Laparoscopic cholecystectomy (LC) has become one of the options for the treatment of acute cholecystitis as surgeons gain facility with this procedure. However, acute suppurative cholecystitis is still a severe condition, because a high mortality rate still exists. In the early years (1991 to 1992), 4 patients were operated on without a preceding percutaneous transhepatic gallbladder drainage (PTGBD) at our hospital, however, one patient died of septic shock after a laparoscopic cholecystectomy. Conversion to open surgery was performed on two patients. However, in later years (1992 to 1995), 14 patients were operated on with preceding PTGBDs safely. Here, we report the safeness and significance of the combination therapy of PTGBD and LC for patients with severe acute suppurative cholecystitis.