Fluoroscopic-guided in vivo gastric mapping for assessment of gastric carcinoma.

RATIONALE AND OBJECTIVES: The authors seek to determine if a new method of combining fluoroscopy and nasogastric biopsy can demonstrate the existence and boundary limits of a known gastric carcinoma or its premalignant conditions. The study is performed in hopes of avoiding unnecessary surgery or limiting resection. METHODS: Two cases are presented to illustrate the technique. The first had a known gastric carcinoma; the other had adenomatous change in the antrum. After topical anesthesia was applied, a nasogastric tube with a coaxial biopsy forceps was inserted. Multiple biopsies were taken in a designed geographic pattern and sent to pathology. The patient with known carcinoma received a total gastrectomy. The specimen was sectioned in the same regions as the biopsies to validate mapping technique. RESULTS: Pathology results for sectioned stomach were nearly identical to the biopsies showing the technique can accurately map the stomach. No adenomatous change in the antrum or other sections of the stomach was observed in the second case. This resulted in the patient being spared gastric resection. CONCLUSIONS: Fluoroscopic-guided gastric mapping can aid in determining the boundaries of a known carcinoma or premalignant conditions. Additional cases and follow-up are necessary.

The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method.

PURPOSE: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. MATERIALS AND METHODS: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. RESULTS: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89%, whereas the sensitivity of greater curvature biopsy is 62%, The difference is considered clinically significant at P < or = 0.05. CONCLUSIONS: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy.

Double-contrast barium examination of the upper gastrointestinal tract with nonendoscopic biopsy: findings in 100 patients.

PURPOSE: To evaluate the performance of double-contrast barium examination of the upper gastrointestinal tract augmented with nonendoscopic gastric mucosal biopsy. MATERIALS AND METHODS: One hundred twenty-six patients (aged 9-81 years) underwent double-contrast barium examination of the upper gastrointestinal tract and nasogastric biopsy. Pathology reports were recovered for 100 patients. These patients' records were searched for procedural complications, sufficiency of biopsy tissue, diagnoses among various age groups, and radiographic findings. RESULTS: Forty-nine (49%) of the 100 patients had biopsy-proved Helicobacter pylori infection with chronic active gastritis. Twenty-one patients (21%) with H pylori-negative biopsy specimens had chronic gastritis. One patient with eosinophilic gastritis and one with granulomatous gastritis were identified. Twenty-nine patients (29%) had negative biopsy results. Nineteen (30%) of the patients with negative barium studies had a positive biopsy specimen, and four (6%) of the patients with positive barium studies had negative biopsy specimens. Eight patients (8%) had a second diagnosis of intestinal metaplasia. CONCLUSION: Use of double-contrast barium examination of the upper gastrointestinal tract combined with nonendoscopic biopsy is quick and safe and can provide reliable histologic information to the primary care physician.

The immunogenicity in humans of a botulinum type F vaccine.

A purified monovalent botulinum type F toxoid vaccine was administered to 35 healthy adult volunteers in a phase I clinical trial. Serum samples from the vaccinated volunteers were evaluated for an antibody response at various time intervals over 1 year by mouse bioassay and ELISA. The antibody response was measured for varying doses of vaccine (2, 5, or 10 microg), and after single or multiple (two or three doses @ 10 microg) vaccinations. Six out of 15 (40%) individuals developed antibody titers after receiving a single dose. After two and three vaccinations, there was a 90% (18/20) and 100% (10/10) seroconversion rate, respectively. Eight months after initial injection, 57 and 63% of individuals were antibody positive following two or three vaccinations, respectively. Single vaccinations, at any of the tested dosages, elicited lower, if any, antibody response than did multiple vaccinations. After the third vaccination, ELISA titers positively correlated with mouse neutralization bioassay titers (r(2)=0.86).

Long-term duration of detectable neutralizing antibodies after administration of live-attenuated VEE vaccine and following booster vaccination with inactivated VEE vaccine.

The US Army successfully developed a live-attenuated Venezuelan Equine Encephalitis (VEE) vaccine, TC-83, in 1961, and subsequently developed a formalin-inactivated vaccine, C-84, in 1974. Initial evaluation of both vaccines was promising, but no long-term safety and immunogenicity data have been reported. This study is the first analysis of the long-term safety and immunogenicity of TC-83 and C-84. From January 1976 to December 1990, 821 laboratory workers at the USAMRIID were vaccinated with a single 0.5 ml subcutaneous (s.c.) dose of TC-83; 128 were boosted with a single 0.5 ml s.c. dose of C-84. Eighty-two per cent of vaccinees responded to TC-83 with an 80% plaque reduction neutralization titer (PRNT80) of > or = 1:20. Minor side-effects were noted in 23% of vaccinees. No long-term sequelae were recorded. Kaplan-Meier analysis showed a 60% probability of vaccinees maintaining a PRNT80 of > or = 1:20 for 5.5-8 years. C-84 was given to two groups: 76 initial nonresponders to TC-83, Group A, and 52 initial responders to TC-83 whose PRNT80 became < 1:20 over time, Group B. C-84 successfully boosted 76% of Group A and 100% of Group B to a PRNT80 > or = 1:20 Kaplan-Meier analysis showed 100% probability of Group B members maintaining a titer of > or = 1:20 for the duration of follow-up, which, in some cases, exceeded 10 years; while Group A had only a 60% probability of maintaining a titer for 1-2 years. Only minor local reactions to C-84 were noted in 6.3% of vaccinees. We conclude that, although TC-83 is reactogenic, when administered as the primary vaccine and C-84 is administered as a boost, these vaccines provide good long-term immunity and are safe in humans. However, a single dose vaccine that is more immunogenic and less reactogenic is needed.

Lumbar spine and femoral neck bone mineral density in idiopathic scoliosis: a follow-up study.

A follow-up study of the bone mineral densities (BMD) of 22 female subjects with idiopathic scoliosis was performed using dual-photon absorptiometry at an average follow-up period of 30.8 months. Compared to the initial scans, statistically significant increases in lumbar spine and femoral neck BMD were observed. When compared to normal subjects, approximately half of the scoliotic subjects were markedly osteoporotic, having BMD measurements at least two standard deviations below the expected value. Scoliotic curvature data could not be correlated with the BMD data. The observed osteoporosis is not transient and appears characteristic of idiopathic scoliosis.

Immunogenicity of an inactivated Rift Valley fever vaccine in humans: a 12-year experience.

Rift Valley fever (RVF) virus causes serious and fatal disease in animals and man. To protect personnel who work with RVF virus in the laboratory, or troops who may be exposed to this virus, the US Army successfully developed an improved version of inactivated RVF vaccine, TSI-GSD-200. From early 1986 to late 1997, 598 at-risk workers at the US Army Medical Research Institute of Infectious Diseases (USAMRIID) were vaccinated as part of an occupational safety and health program. The subjects of this study received three subcutaneous doses (0, 7 and 28 days) of 0.5 ml of TSI-GSD-200. A total of 540 vaccinees (90.3%) initially responded (group A) with an 80% plaque-reduction neutralization antibody titer (PRNT80) of > or =1:40; whereas 58 subjects (9.7%) were initial nonresponders (group B) failing to achieve this titer. Volunteers who either failed to respond or who achieved a titer of > or =1:40 but whose titer waned below 1:40 were boosted 1-4 times with the same vaccine. Among 247 group A subjects who received the first recall injection, 242 (98%) were successfully boosted, achieving a PRNT80 > or =1:40. Thirty-three of 44 (75%) initial nonresponders were converted to responder status after the first booster, which is a lower rate than that of group A (P < 0.001). After the primary series and the first booster, Kaplan-Meier analysis showed 50% probability of group A members maintaining a titer of > or =1:40 for approximately eight years; whereas group B had a 50% probability of maintaining a titer for only 204 days. Group A immune response rates to boosts 1-4 ranged from 87 to 100% with geometric mean titers (GMTs) ranging from 80 to 916. Boosts 1-4 immune response rates of group B volunteers ranged from 67 to 79% with GMTs ranging from 90 to 177. Minor side effects to TSI-GSD-200 were noted in 2.7% of all vaccinees after primaries and 3.5% of all vaccinees who had primaries and up to four boosters. We conclude that the use of TSI-GSD-200 is safe and provides good long-term immunity in humans when the primary series and one boost are administered.