High Helicobacter pylori eradication rate with a 1-week regimen containing ranitidine bismuth citrate.

BACKGROUND: High Helicobacter pylori eradication rates have consistently been reported with 2-week dual therapy regimens of ranitidine bismuth citrate plus clarithromycin. Ranitidine bismuth citrate with two antibiotics may provide an alternative 1-week eradication regimen. METHODS: This double-blind, randomized, parallel group, international, multicentre study compared ranitidine bismuth citrate 400 mg b.d. and clarithromycin 500 mg b.d. for 2 weeks (RC) with ranitidine bismuth citrate 400 mg b.d., clarithromycin 500 mg b.d. and metronidazole 400 mg b.d. for 1 week (RCM) for eradication of H. pylori in 350 patients with dyspepsia. RESULTS: Treatment with RC and RCM eradicated H. pylori (established by the combination of two negative results from two discrete 13C-UBTs at nominal weeks 4 and 12) from 89% (95% CI: 84-94) and 92% (95% CI: 88-97) of the observed population, and from 78% (95% CI: 72-84) and 80% (95% CI: 75-86) of the intention-to-treat population. When established only by one negative 13C-UBT result at least 28 days after the end of treatment, the respective intention-to-treat rates were 85% (95% CI: 79-90) and 88% (95% CI: 83-93). Both regimens were well-tolerated, only 6% of patients given RC and 4% given RCM discontinued treatment. Median plasma bismuth concentrations at the end of the second week of study were low, at 3.5 and 0.4 ng/ mL, respectively. CONCLUSIONS: Ranitidine bismuth citrate triple therapy for 1 week (RCM) and dual therapy for 2 weeks (RC) were equally effective for the eradication of H. pylori infection.

[Loop ileostomy--the first choice for relief of colon and rectum]. / Loop-ileostomi--første valg ved aflastning af colon og rectum.

In numerous comparative investigations, loop-ileostomy has proved superior to transversostomy. The operative technique is described and experience from 27 loop-ileostomies carried out in a department for organ surgery are reviewed. The qualities of the method as compared with transversostomy are discussed on the basis of the literature and the authors' own results. It is concluded that loop-ileostomy may, in general, be preferred for temporary and palliative relief of the colon.

[Undescended testis treated by intranasal application of luteinizing hormone-releasing hormone (LH-RH)]. / Non-descensus testis behandlet med intranasalt appliceret luteiniserende hormon/frigørende (releasing) hormone (LH-RH).

In a double-blind, placebo-controlled study, 118 boys, aged 2-12 years, with 161 undescended testes were treated with luteinising-hormone releasing-hormone (LH-RH), 1.2 mg daily intranasally for four weeks. According to randomization, 60 boys with 85 undescended testes received LH-RH and 58 boys with 76 undescended testes received the placebo. 17 testes (20%) in 12 boys (20%) descended in the LH-RH group and 2 testes (3%) in 2 boys (3%) descended in the placebo group. This difference is statistically significant (chi 2, 0.01 greater than p greater than 0.001). A second LH-RH course, offered three months later to the boys who did not respond to the first LH-RH course, increased the success rate to 35%. The primary location of the testis was a significant factor for the effect of treatment. The highest success rate (63%) was registered in testes located in a high scrotal position. There was no significant difference in success of treatment between unilateral and bilateral cryptorchidism, nor between age groups. No serious adverse effects of treatment were noted. It is concluded, that LH-RH administered intranasally can be used in the treatment of boys with unilateral and bilateral cryptorchidism.

[Factors determining the development of wound infection after appendectomy]. / Faktorer bestemmende for udviklingen af sårinfektion efter appendektomi.

In order to illustrate which factors are of significance for the development of wound infection after appendectomy, an extensive prospective material of 2,097 patients submitted to appendectomy was analysed. Regression analyses demonstrated that age alone, employment of preoperative antibiotics (cefoxitin) and patient delay (time from onset of symptoms till admission) were of significance. The present authors conclude, on the basis of this material, that all patients over 25 years of age should be given preoperative antibiotic prophylaxis which covers aerobic and also anaerobic microorganisms. If a gangrenous or perforated appendix is found, antibiotics should be administered intraoperatively if prophylactic treatment has not been administered. In cases of perforation, antibiotics should be administered postoperatively for 72 hours.

Sucralfate in gastritis.

Gastritis has a wide spectre of definition modalities. Most previous studies have compared symptomatology with histologic gastritis with negative results. We believe that this may be due to inadequate definition criteria and emphasize this point by comparing gastroesophageal reflux with duodenogastric reflux. A prospective randomized trial has been conducted for half a year comparing Sucralfate with a placebo in patients with symptomatological and macroscopical gastritis. Although approximately one hundred patients met the endoscopic criteria, the vast majority could not be included due to well-defined interfering diseases, and thus the material is still too sparse to give any indication of the influence of Sucralfate on endoscopic gastritis, although the preliminary overall results seem promising.

Conservative treatment of 155 cases of perforated peptic ulcer.

During 23 years a total of 155 cases of verified perforated peptic ulcer were treated conservatively, according to the routine of the department, with a complication rate of 31%, and a mortality rate of 10%. Out of the 16 deaths, 4 patients were moribund at the admission, and 10 of the 12 remaining patients had a severe associated disease. Therefore, results of conservative treatment cannot be judged from results in this group. In fact, the overally mortality rate was not not higher in this material than usually reported after surgical intervention. Long-term results (mean 11 years) in 93 patients were satisfactory in 18 our of 28 patients with acute ulcer, and in 31 out of 65 patients with chronic ulcer. The reperforation rate was 9.7%.

Intestinal ischemia due to vascular elastosis caused by metastasizing carcinoid tumor of Meckel's diverticulum.

A case of a carcinoid tumor arising in a Meckel's diverticulum is reported. By the time of detection, the tumor had spread to the mesentery causing ischemia of the small intestine due to the associated vascular elastosis.

Does internal urethrotomy prevent urethral stricture after transurethral prostatectomy. Early and late results.

In a randomized study of 200 consecutive patients undergoing transurethral prostatectomy (TURP), the combination of internal urethrotomy and TURP (the trial group) was compared with TURP alone (the control group) with regard to the development of urethral strictures postoperatively. Three months after resection, 14% in the trial group and 21% in the control group had developed a urethral stricture. The difference was not statistically significant. At a late follow-up (median 54 months postoperatively) 5 more patients in the trial group and 8 in the control group had developed strictures. The diagnostic specificity and sensitivity of uroflowmetry in diagnosing urethral strictures was 62 and 96%, respectively. The diagnostic specificity and sensitivity of retrograde urethrography was 58 and 98%, respectively. We conclude that urethrotomy before TURP cannot prevent the formation of postoperative urethral strictures.

The value of parietal cell vagotomy compared to simple closure in a selective approach to perforated duodenal ulcer. Operative morbidity and recurrence rate.

Of 168 consecutive patients presenting with a perforated duodenal, pyloric or prepyloric ulcer, 123 patients were judged fit or suitable for parietal cell vagotomy (PCV). It was, however, only added to simple closure in 67 patients with a previous history of dyspepsia prone to develop recurrent ulceration, whereas 56 patients with no previous symptoms and an established low risk of recurrence were managed by simple closure only. In the comparable groups, postoperative morbidity did not differ, entailing mortality rates of 4.5% and 5.3% following PCV or simple closure only. An overall clinical grading of 106 patients (91%) followed up (median 4 years, range 1-10 years) revealed equally good results. In patients with previous dyspepsia and an established high recurrence rate if managed by simple closure only, a satisfactory reduction of the recurrence rate was found when PCV was added to suture closure (cumulative recurrence rate 20.7 +/- SD 69 compared to 29% +/- SD 9.4 following simple closure in patients with no previous dyspeptic symptoms). It is concluded that in patients with a perforating duodenal ulcer deemed fit or suitable for PCV, assessed by good clinical judgement, PCV does not carry an added risk and provides a fairly good protection against recurrent ulceration.

Detrusor instability in children with recurrent urinary tract infection and/or enuresis. I. Clinical conditions and symptomatology.

Forty-one children, aged 5-15 years, were referred because of recurrent urinary infections and/or enuresis. They were examined prospectively by means of cystometry. CO2 cystometry revealed detrusor instability in 18 children (44%), but if complete reproducibility were to be requested in repeated tests, only 7 children (17%) would have presented instability. Detrusor instability was not significantly related to definite pathological changes in the urinary tract or to irritative bladder symptoms.

Detrusor instability in children with recurrent urinary tract infection and/or enuresis. II. Treatment.

Of 41 children, aged 5-15 years, referred consecutively because of recurrent urinary tract infections (UTIs) and/or enuresis, 18 (44%) showed detrusor instability (DI) in at least 2 of 6 CO2 cystometries. One child was excluded from the study because of lack of follow-up. Four children with less pronounced DI (instability during less than or equal to 50% of the cystometries performed) and frequent UTIs were given antibiotics prophylactically for 3 months. In the remaining 13 children, DI was found during more than half the cystometries performed, and 11 of these children, who also had urge incontinence, were treated with emepronium bromide, 400-600 mg daily (10-12 mg/kg) for 3 months. In 7 of the patients this treatment was supplemented by antibiotics prophylactically because of frequent UTIs. Two children with special problems received other types of treatment. All children were free from symptoms at a clinical check-up 6 months later, 95% confidence limits 0-20%.

Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections?

In a prospective study 33 children (aged 6-14 years) consecutively referred for recurrent urinary tract infections (RUTI), underwent intravenous urography (IVU) as well as voiding cystography (VC). Seven children had unilateral and two children had bilateral renal scarring, while ten children had unilateral and six children had bilateral vesico-ureteral reflux (VUR). Following normal IVU VUR was demonstrated in 22% of the ureters, but in all cases of low grade. In abnormal IVU, i.e. renal scarring or dilatation of the ureters, VC showed high grade VUR in 54% of the ureters. Based on these results and the current theories on the significance of patient age and grade of VUR, we conclude that in case of a normal IVU in children with RUTI and age of at least 6 years, there is no reason to supplement the pre-treatment evaluation with VC.

Protective effect of implanted autologous splenic tissue in splenectomized rats exposed to i.v. Streptococcus pneumoniae.

The protective effect of splenic implantation or hemisplenectomy on the survival rate was studied in 34 Wistar rats inoculated intravenously with 8.5 x 10(6) CFU Streptococcus pneumoniae type 25, 4 months prior to the bacterial challenge, different surgical procedures were performed, dividing the animals into 5 equally large groups: (1) sham operation, (2) hemisplenectomy, (3) splenectomy with a 100% reimplantation, (4) splenectomy with a 50% reimplantation, and (5) splenectomy without reimplantation. The observation period after the bacterial inoculation was 13 d. Differences in mean survival rates were found: (1) 13 d, (2) 10.6 d, (3) 7.1 d, (4) 5.6 d, and (5) 3.1 d. The increasing survival rates correlated with increasing weights of the residual splenic tissue. This animal study indicates that residual splenic tissue may account for a lesser tendency to infection.

Uroflowmetry in neurologically normal children with voiding disorders.

A prospective study was undertaken to delineate the role of spontaneous uroflowmetry as screening procedure for functional infravesical obstruction (detrusor/sphincter dyssynergia). More than 70% of thirty-nine children referred for urinary tract infections and/or enuresis in the absence of neurological deficits underwent a complete diagnostic program including intravenous urography, voiding cystography and cystoscopy as well as spontaneous uroflowmetry, cystometry-emg and pressure-flow-emg study. The incidence of dyssynergia was 22%. However, neither the flow curve pattern nor single flow variables were able to identify children with dyssynergia. Consequently uroflowmetry seems inefficient in the screening for dyssynergia in neurological normal children with voiding disorders in the absence of anatomical bladder outlet obstruction.

Voiding patterns in men evaluated by a questionnaire survey.

A questionnaire on obstructive and irritative voiding symptoms was sent to 572 men aged between 20 and 79 years, selected at random from the National Register; 337 questionnaires were completed. None of the responders had consulted a doctor because of voiding symptoms. There was a significant increase in voiding symptoms and in the obstructive, irritative and total symptom scores between the sixth and seventh [corrected] decades, whereas the increases in the other decades were small. Only the prevalence of terminal dribbling was uniform. The prevalence of single obstructive and irritative voiding symptoms in men aged 60 to 79 years without subjective prostatism was the same as in patients admitted with prostatism, although most of the men had milder symptoms. Only nocturia and urge incontinence were more prevalent in patients admitted with prostatism. About 20% of men in the oldest decades had symptoms equal in severity to those found in men undergoing prostatectomy; 29% and 11% of men in the eighth decade [corrected] had nocturia twice and 3 times or more respectively; 19% complained of urge incontinence. More information on possible treatment is needed.

Voiding patterns and prevalence of incontinence in women. A questionnaire survey.

A detailed questionnaire on the occurrence of irritative and obstructive voiding symptoms, incontinence and the number of childbirths was sent out to 600 women aged between 20 and 79 years, randomly selected from the National Register; 432 (72%) returned the questionnaire and 414 (69%) were evaluable. The frequency of obstructive symptoms such as hesitancy, intermittency and decreased stream was low. Diurnal frequency with voiding intervals less than 3 h were recorded by more than 50% of the women and about 10% voided more frequently than every second hour. Nocturia increased significantly with age; 54 (13.6%) voided at least twice per night. About 40% complained of incontinence but this was troublesome in only 6%; 15.3, 13.3 and 11.5% had stress, urge and mixed incontinence respectively. More than 8% wore nappies or sanitary towels every day to protect against urinary leakage. Although the tendency to wear nappies or sanitary towels increased with age, the increase was not statistically significant. There was a positive correlation between the occurrence of stress incontinence and childbirth in the group as a whole.