Small bowel bacterial overgrowth in strongyloidiasis.

Small bowel bacterial growth was studied in patients with strongyloidiasis, and the results were compared to controls. We concluded that in strongyloidiasis there is small bowel bacterial overgrowth, and so it should be considered in the pathogenesis of some of the gastrointestinal manifestations and complications of strongyloidiasis.

[Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial]. / Ranitidina em dose única noturna no tratamento da úlcera duodenal. Resultado de um estudo aberto, multicêntrico, comparativo.

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.

[Influence of diet composition on the late course of acute pancreatitis. Experimental study in rats]. / Influência do regime alimentar na evolução tardia da pancreatite aguda. Estudo experimental em ratos.

Acute pancreatitis was induced with sodium taurocholate 1% in two lots of rats fed during 21 days with diets that differed in lipid composition. Serum amylase, pancreatic tissue enzymes (trypsinogen, chymotrypsinogen and amylase), pancreatic tissue nucleotides (RNA and DNA) and biopsies for histological study were collected in normal pair fed animals, and in the experimental lots 1, 4, 7 and 15 days after AP was induced. ANOVA and Student t-test were used for the comparison of biochemical data (p less than 0.05). They showed that acute pancreatitis aggravated progressively until the fourth day independently of the regimen. On the 15th day, the histological and biochemical parameters reached normal values. The authors concluded that high lipidic diet was not the main factor responsible for progressive injury of the pancreas.

Bile acids do not regulate the intestinal mucosal cholesterol synthesis: studies in the chronic bile duct-ureter fistula rat model.

Control male Wistar rats with intact bile circulation, animals with a bile duct-right ureter fistula, and bile duct-right ureter fistula rats fed taurocholic acid (5.5 mg/day) were maintained on a cholesterol-free pellet diet and pulse labeled subcutaneously with radioactive cholesterol. Bile acid feeding did not interfere with the synthesis of cholesterol by the intestinal mucosa or by the whole body in spite of markedly lowering the production of bile acids. Of the total fecal cholesterol mass in bile fistula animals roughly 25% originated from plasma filtration and 75% was ascribed to local mucosal cholesterol synthesis.

[Treatment of gastric ulcer with ranitidine: comparison of a single 300 mg dose at night with 150 mg twice a day]. / Tratamento da úlcera gástrica com ranitidina: comparação da dose única noturna de 300 mg com a de 150 mg duas vezes ao dia.

Twenty five patients with endoscopically diagnosed gastric ulcer, were randomly allocated to treatment with ranitidine 300 mg at night or ranitidine 150 mg twice daily. After six weeks, ulcer healing was observed in 7 out of 14 patients (50%) treated with ranitidine 300 mg nocte and in 7 out of 11 (63.6%) receiving 150 mg bid. Cumulative healing rates at 12 weeks were 64.2% and 81.8%, respectively. There was no statistically significant difference between these two groups. No adverse events were reported by any patient. Ranitidine 300 mg administered at night was effective and a safe regimen for the treatment of gastric ulcer.

Is the inhibition of nocturnal gastric acid secretion the most important factor in duodenal ulcer treatment? A comparison between the effectiveness of single morning and nocte doses of ranitidine 300 mg.

Fifty-five patients with an endoscopically confirmed duodenal ulcer were randomly allocated to receive ranitidine 300 mg either in a single morning or a single nocte dose (26 and 29 patients respectively). They were endoscopically examined at the end of the second week and when the ulcer was still active, the patient was treated for another two weeks, when endoscopy was repeated. Patients with ulcers still active at four weeks were considered treatment failures. The healing rate observed when ranitidine 300 mg was given in the morning was 10/26 (38%) at the end of the second week and 17/26 (65%) at the end of the fourth week. The healing rates after the 300 mg nocte treatment was 12/29 (41%) at the end of the second week and 20/29 (68%) at the end of the fourth week. No side effects were observed in any of the 55 patients, although one patient in the morning regimen bled at the end of the second week and was withdrawn from the study. Our results showed that ranitidine 300 mg in a single morning dose is as effective as when given in a single night dose. This finding is suggestive that reduction of nocturnal gastric acid secretion is important, but not essential for the healing of duodenal ulcer.

[Chronic pancreatitis: clinical characteristics, complications and association with other diseases]. / Pancreatites crônicas: características clínicas, complicações e associação com outras afecções.

The clinical aspects, complications and association with other diseases were investigated in 407 patients with chronic pancreatitis. The most frequent symptoms were abdominal pain (93.6%), weight loss (91.6%), diabetes (37.8%) and malabsorption (31.7%). Pancreatic cysts (32.6%), ascites and/or pleural effusion (12.5%), pancreatic necrosis (11.2%), gastrointestinal bleeding (12.8%) and pancreatic abscess (7.3%) were the most frequent complications. The symptoms and complications observed are discussed and their incidences compared to those reported from other countries.

[Spontaneous remission of pancreatic cysts in patients with chronic pancreatitis]. / Regressão espontânea de cistos pancreáticos em portadores de pancreatite crônica.

Thirty one alcoholic patients with pancreatic cysts were studied by ultrasonographic scanning with the purpose to observe the evolution of the cysts. The mean time of the follow-up was 15.6 +/- 9.2 months; the patients were aged 40.2 +/- 9.3 years (male = 93.5%; female = 6.4%) the average pure ethanol intake was 288.3 +/- 185.9 ml for a period of 20.8 +/- 9.3 years. In 21 of the 31 patients (67.7%) the ultrasonographic examination showed total spontaneous resolution of the cysts within a time span of less than 18 months. The majority of the parameters studied (age, time and volume of ethanol intake, pain, diabetes, calcifications and previous cyst drainage) had no relation with the evolution of the cysts. In 11 patients (52.3%) the cysts showed an initial enlargement before decreasing in size. The cysts located in the pancreatic head showed less tendency to spontaneous resolution. Complications were observed in two patients: intra-cystic haemorrhage in one and rupture into the peritoneal cavity in the other. Our observations suggest that patients with pancreatic cysts secondary to chronic alcoholic pancreatitis should be controlled with periodical ultrasonography. Surgical approach should be reserved for patients with complications.

[Etiology of chronic pancreatitis in São Paulo: a study of 407 cases]. / Etiologia das pancreatites crônicas em São Paulo: estudo de 407 casos.

The etiology of chronic pancreatitis was investigated in 407 patients: 381 (93.6%) had a history of heavy alcoholic ingestion (average = 295.3 +/- 171.3 g of ethanol) during a time of 19.2 +/- 8.0 years: five patients (1.0%) had familial background of pancreatitis, two (0.5%) had the obstructive form, and two (0.5%) presented history of malnutrition. In 18 patients (4.4%) it was not possible to determine the etiology. Patients with the alcoholic form started the alcohol abuse at the age of 19.4 +/- 6.0 years. A careful dietetic inquiry showed that patients with chronic pancreatitis lived on a diet which was significantly richer in protein than that of patients of the control group (p less than 0.01). Attention is called to the high incidence of chronic alcohol abuse in patients with chronic pancreatitis.

Coffee drinking in patients with duodenal ulcer and a control population.

The ingestion of plain coffee was compared in 150 duodenal ulcer patients (DU) and 100 control subjects without digestive complaints (C). The DU and C groups were registered in accordance with their daily consumption of coffee: none, 1-100 ml, 101-300 ml, 301-500 ml, and more than 500 ml. Fifty millilitres of coffee as prepared in Brazil contain around 50 mg of a caffeine, which is 2.8 times more than in an equal volume of coffee in the United States. Patients with DU stopped drinking coffee or reduced the volume significantly after symptoms started. There was a significant change in coffee intake at all volume levels except at 1-100 ml. The main reason for the reduction of coffee ingestion was the relationship observed by the patients between the consumption of coffee and dyspeptic complaints. Our results suggest a close correlation between the ulcer-like symptoms and the amount of coffee ingested by patients with duodenal ulcer.

[Effect of H2 blockers on the surgical indications for peptic ulcer]. / Influência dos bloqueadores H2 na indicação da cirurgia para úlcera péptica.

The effects of introduction of cimetidine therapy were studied by an analysis of all cases of peptic ulcer who came to be operated at the Hospital das Clinicas of the University of São Paulo in the period between 1966 and 1985. A reduction in the frequency of surgical interventions especially after 1978, was verified. Ten percent of all cases operated between 1973 and 1985 and chosen at random were studied in a more detailed way. A reduction in the number of operations for gastric and duodenal ulcers was found. There was a greater interval between diagnosis and surgery, an increased number of operations for stenosis and hemorrhagic peptic ulcers and a reduction in frequency of operations for perforated peptic ulcer. There were no significant differences as to the sex and age of patients, except in cases of perforated peptic ulcer, with a larger number of female patients.

Response of the lower esophageal sphincter to pentagastrin on patients with megaesophagus secondary to Chagas' disease.

In 12 patients with moderate chagasic megaesophagus the lower esophageal sphincter pressure was studied under basal conditions and after i. v. infusion of pentagastrin by open tips infused rapid pull through manometry. Pentagastrin was infused in graded doses of 0.5, 1.0, 2.0 and 4.0 micrograms/kg/h. Results were compared with those of 12 healthy controls. Mean basal pressure in the megaesophagus group was significantly higher (p less than 0.05) than in the control group (36.2 +/- 2.5 and 27.4 +/- 1.8 cmH2O, respectively). Following pentagastrin infusion all the values of the lower esophageal sphincter pressure were significantly higher in the chagasic group (p less than 0.05). The plateau was achieved with 0.5 micrograms/kg/h in the control group and with 1.0 micrograms/kg/h in the chagasic group (p less than 0.05). Furthermore, the patients with megaesophagus needed a higher dose of pentagastrin to achieve the maximal contraction.

[A hyperlipidic diet and acute pancreatitis: experimental study in rats]. / Dieta hiperlipídica e pancreatite aguda: estudo experimental em ratos.

After acute pancreatitis was induced, the residual pancreatic tissue contents were evaluated in two series of rats fed with diets that differed in the lipidic composition: 1--high lipid and balanced protein diet; 2--balanced diet. Total protein, nucleic acids, trypsinogen, chymotrypsinogen were quantified in the pancreatic tissue; amylase activity was measured in the pancreatic tissue and serum under the following conditions: 1--in rats fed "ad libitum" (groups CB and CL); 2--in rats submitted to a fast of 30 hs (groups JB and JL) and 3--twenty-four hours after acute pancreatitis was induced (group B and L). The results obtained were statistically compared among groups with the same kind of diets, using ANOVA and the Tukey test. Student t-test was used to compare the same parameters among similar groups with different diets (p less than 0.05). In comparison with the groups under same regimen it was verified that the pancreatic enzymes content didn't change in fasting groups, but did in PA groups. It was also found that trypsin was increased in all groups, RNA/DNA decreased and total protein increased in AP group in rats fed with hyperlipidic diet. It is concluded that high lipid intake can aggravate pancreatic injury.

[Echographic study of cystadenoma and cystadenocarcinoma of the pancreas]. / Estudo ecográfico dos cistadenomas e cistadenocarcinomas do pâncreas.

The ultrasonographic aspects of cystadenomas and cystadenocarcinomas of the pancreas were studied in 14 patients. The tumors were cystic, solid or of mixed type. The ultrasonographic differences between the benign and malignant lesions are discussed, as well as changes concerning the splenic vein and biliary system. Ultrasonography is of help for the differential diagnosis of cystic tumors of the pancreas and for indication of the best therapeutic procedure.

Contribution of plasma protein and lipoproteins to intestinal lymph: comparison of long-chain with medium-chain triglyceride duodenal infusion.

In rats with intestinal lymph-fistula and electrolyte and protein losses continuously replaced by I.V. infusion, the plasma to lymph filtration of total protein, albumin, and cholesterol was similar after duodenal infusion of either long-chain (LCT) or medium-chain (MCT) triglyceride. Filtration of cholesterol into intestinal lacteals was also measured after pulsed I.V. administration of 14C-beta-sitosterol as an indirect marker for passage of lipoproteins into the lymph system. During intraduodenal administration of LCT and constant I.V. infusion of 125I-apo high density lipoprotein (HDL), intact plasma HDL appeared in lymph and contributed apo-LP to chylomicron formation. Nevertheless, most lymph apo-LP originated from local mucosal synthesis.

Jejunal flora of patients with megaoesophagus secondary to Chagas disease.

The jejunal flora of 15 patients with megaoesophagus secondary to Chagas disease was studied and compared with that of 15 control individuals. In addition to the serological reactions for Chagas disease (immunofluorescence and complement fixation reaction), all subjects were submitted to endoscopy and X-ray of the oesophagus, gastric secretory study and investigation of the jejunal flora. The mean bacterial counts (log10) of Chagas disease patients (4.14 +/- 2.15 c.f.u./ml) was significantly higher than those of the control group (2.83 +/- 1.34 c.f.u./ml). Aerobic bacteria were isolated from 14 Chagasic patients (maximum count 10(10) c.f.u./ml) and 7 controls (maximum count 10(5) c.f.u./ml). Anaerobes were isolated from 7 patients (maximum count 10(7) c.f.u./ml) and 1 control (10 c.f.u./ml). Controls and Chagas disease patients differed significantly in the maximum acid output, but there was no statistically significant relation between bacterial counts and maximum output.

Protective effect of a protein-free diet in acute experimental pancreatitis.

1. Survival time, amylase activity and pancreatic protein, DNA and RNA content were measured in 38 control rats and in 104 rats injected with sodium taurocholate to induce acute pancreatitis after 21 days on one of four diets differing in protein, lipid and carbohydrate content. 2. All of the parameters measured were lower in rats with pancreatitis than in controls maintained on the same diets. Among the rats with pancreatitis, those receiving a protein-free diet survived longer and had significantly higher DNA, lower amylase activity and lower RNA and protein levels than those receiving a balanced diet or one that was high in protein or lipid content. 3. We conclude that acute pancreatitis in rats has a more benign course in protein-undernourished animals.

[Splenic vein thrombosis as cause of digestive hemorrhage: ruptured esophageal varices or hemorrhagic gastritis secondary to portal hypertension?]. / Trombose da veia esplênica como causa de hemorragia digestiva: varizes gástricas rotas ou gastrite hemorrágica secundária à hipertensão portal?

The clinical evolution and treatment of two patients with alcoholic chronic pancreatitis complicated with digestive hemorrhage localized in the gastric corpus and fundus are discussed. The clinical picture and the endoscopic features suggested that the hemorrhage was due to hemorrhagic gastritis and not to rupture of varicose veins. Hemorrhagic gastritis as a consequence of segmentary portal hypertension may be responsible for the difficulty in establishing the etiology of digestive hemorrhage in such cases.

Protective effect of a protein-free diet in acute experimental pancreatitis

1. Surgical time, amylase activiry and pancreatic protein, DNA and RNA content were measured in 38 control rats and in 104 rats injected with sodium taurocholate to induced acute pancreatitis after 21 days on one of four diets differing in protein, lipid and carbohidrate cocnent. 2. All of the parameters measured were lower in rats with pancreatitis than in controls maintained on thes same diets. Among the rats with pancreatitis, those reciving a protein-free survived longer and had significantly higher DNA, lower amylase activity and lower RNA and protein levels than those reciving a balanced diet or one that was high in protein or lipid content. 3. We conclude that acute pancratitis in rats has a more benign course in protein-undernourished animals