Peptides specific for Mycobacterium avium subspecies paratuberculosis infection: diagnostic potential.

Mycobacterium avium subspecies paratuberculosis (Map) is the causative agent of Johne's disease (JD). Current serological diagnostic tests for JD are limited by their sensitivity when used in sub-clinical stages of the disease. Our objective was to identify peptides that mimic diagnostically important Map epitopes that might be incorporated into a new-generation JD diagnostic. Four peptides were isolated from a phage-displayed random peptide library by screening on antibodies derived from Map-infected goats. The peptides were recognised by antibodies from Map-infected goats but not by antibodies from uninfected goats. The peptides elicited immune responses in rabbits, which reacted strongly with bona fide Map antigens proving the peptides were true epitope mimics. To assess the diagnostic value a panel of goat sera was screened for reactivity's with peptides. The peptides were recognised by antibodies from a proportion of goats infected with Map compared with control animals with a diagnostic specificity of 100% and the sensitivity ranged from 50 to 75%. Combinations of any two peptides improved sensitivity 62.5-87.5% and 100% sensitivity was achieved with three of the four peptides in combination. These data suggest peptides representing diagnostically important Map epitopes could be incorporated into a sensitive diagnostic test.

A single dose of intravenous esomeprazole decreases gastric secretion in healthy volunteers.

BACKGROUND: Data suggest that esomeprazole decreases gastric secretion. AIMS: To assess the effect of a single i.v. esomeprazole dose on gastric secretion volume 3 h after drug administration, as a primary endpoint, and to evaluate, as secondary endpoints, the reduction 1 and 5 h after dosing; time when the gastric pH was <2.5 and esomeprazole's safety. METHODS: In all, 23 healthy Helicobacter pylori-negative volunteers (10 men, 13 women, mean age 28.2 +/- 6) participated in this single-centre, randomized, double-blind, placebo-controlled, 2-way, single-dose cross-over study. In different sessions, volunteers received i.v. either esomeprazole 40 mg or placebo. An inserted double-lumen nasogastric tube perfused and aspirated gastric liquid. Mechanical fractioned aspiration measured secretion volume; aliquot spectrophotometry assessed gastric secretion volume lost to the duodenum. RESULTS: Three hours post-i.v. esomeprazole, average gastric secretion decreased by 77.6% (vs. baseline) compared to placebo. Values 1 and 5 h after dosing were 73.5% and 74.5%. Five hours after esomeprazole, the gastric pH was <2.5 3.9% of the time and 73.3% after placebo (P < 0.002). Esomeprazole was well-tolerated. No serious adverse events occurred. CONCLUSIONS: Intravenous esomeprazole decreases gastric secretions. The potential clinical impact in averting bronchoaspiration during anaesthesia induction and in intensive care patients should be investigated in further studies.

[Long-term treatment of patients with symptomatic gastroesophageal reflux disease comparing costs and efficacy over 6 months of treatment with Nexium On-Demand Treatment or Nexium continuous treatment. An open, randomised multi-center study]. / Wirksamkeit und Kosten einer kontinuierlichen Langzeit- behandlung mit Esomeprazol versus einer Anwendung bei Bedarf bei symptomatischen Reflux-Patienten in der Praxis ohne endoskopische Abklärung-die ONE Studie (On-demand Nexium Evaluation).

This open, randomized study (ONE: On-demand Nexium Evaluation) compared the two long-term management options with esomeprazole 20 mg--continuous daily or on-demand treatment--in endoscopically uninvestigated patients seeking primary care for symptoms suggestive of gastroesophageal reflux disease (GERD) who demonstrated complete relief of symptoms after four weeks of initial treatment with esomeprazole 40 mg. In total 1904 patients were randomized. During 26 weeks 913 patients received continuous daily therapy with esomeprazole 20 mg, once daily, while 991 patients were treated with esomeprazole 20 mg on-demand. The continuous therapy offered slightly better relief of the symptom heartburn, however esomeprazole 20 mg taken on-demand was associated with lower direct medical costs. Esomeprazole was generally well tolerated.

[Laparoscopic colon reposition and closure of the diaphragm in secondary incarcerated pre-existent diaphragmatic hernia]. / Laparoskopische Colonreposition und Zwerchfellverschluss bei sekundär incarcerierter vorbestehender Zwerchfellhernie.

We report on a 28-year-old patient, who acquired a left diaphragmatic hernia after suffering a motorcycle accident seven years ago. The diaphragmatic hernia was not diagnosed at that time. After a laparoscopic cholecystectomy performed for acute cholcystitis, there was herniation and secondary incarceration of a bowel segment into the preexistent diaphragmatic hernia. We describe laparoscopic surgical repositioning of the bowel segment and closure of the diaphragmatic defect.

[Laparoscopic excision of a urachus umbilical fistula]. / Laparoskopische Excision einer Urachusnabelfistel.

We report on a 24-year-old female patient with a chronic secretion from an umbilical fistula. We describe the laparoscopic removal of the fistula using two 5-mm and two 10-mm ports.

[Laparoscopic endoscopic pre-peritoneal combined hernia operation in incarcerated indirect inguinal hernia]. / Laparoskopisch endoskopisch-präperitoneale kombinierte Hernien-Operation bei incarcerierter indirekter Inguinalhernie.

We report on a 73-year-old patient with an incarcerated right sided groin hernia. First the incarcerated small bowel was gently retracted laparoscopically; then using the extraperitoneal endoscopic approach the hernial sack was redused and a 15/13 cm prosthesis (polypropylene mesh) brought in appropriate position and fixed with endo-staples. Prior to closing the trocar-incisions the vitality of the small bowel was checked once again laparoscopically.

[Inguinal hernia as a sequela of disordered bladder emptying?]. / Leistenhernie als Folge gestörter Blasenentleerung?

We examined 56 patients with hernias and 49 patients with other diseases prior to operation. They were all above 50 years of age. The urological screening examination included the patients history of the frequency of urination during night and day time, dysuria, the common risk factors (smoking, coughing, obstipation), obesity, a sonographic measurement of the prostate diameters, a sonographic evaluation of residual urine and the determination of the urinary flow rate. None of the above parameters showed a significant difference between the two groups. Surprisingly more than 60% of all men showed a pathological voiding function (either residual urine and/or a pathological flow rate). Our conclusions are: 1. Patients with inguinal hernias do not show a greater incidence of pathological bladder function than patients of the control group. The benign prostatic hypertrophy as a risk factor for the development of inguinal hernias is most questionable. 2. Because the results showed no significant difference between the two groups, a determination of residual urine prior to operation is not necessary. 3. More than 60% of the men above 50 years showed a pathological voiding function. We recommend a urological screening test for all men above 50 years of age during hospitalisation.