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Campylobacter pylori (CP) infection among healthy employees at the section of gastroenterology was studied by means of the carbon-14 urea breath test. Fourteen of 46 individuals (30.4%) were infected with Campylobacter pylori (CP+). Eleven CP+ individuals were treated with a low-dose regimen of antacids (four tablets a day) for 2 weeks. The 14C recovery dropped from 8.36 ± 1.26% before treatment to 5.70 ± 1.24% (p = 0.023) approximately 12 h after the last intake of antacids, a 31.8% reduction, indicating suppression but no eradication of the C. pylori infection. A new breath test 2 weeks after cessation of treatment indicated that the suppressive effect of antacid on C. pylori infection was short-lived.

The 14C-urea breath test is claimed to be the best test for detection of Helicobacter pylori infection. We present a procedure for estimating its cutoff value on the basis of biometric evaluation only, without involving other diagnostic methods. Cumulative gastric urease activity (CA) was determined during the first 30 min after oral administration of 14C-urea (92.5 kBq) in 56 random volunteers and 49 consecutive patients with peptic ulcer disease. The distribution of CA in random volunteers was positively skewed. Logarithmic transformation yielded two separate populations, each normally distributed. Their normal probability density functions intercepted at log cutoff value. A bimodal distribution of log CA was confirmed in patients with peptic ulcer disease before and after treatment aimed at H. pylori eradication. Cutoff values were determined for both random volunteers and patients with peptic ulcer disease. By application of the present procedure for determination of cutoff value, the 14C-urea breath test distinguishes between individuals who have an increased gastric urease activity and individuals who do not, with the smallest possible arbitrariness.

Suspensions of aluminium hydroxide or a commercial antacid containing aluminium hydroxide (Trigastril®) was instilled intragastrically in rats in doses comparable to high and low human therapeutic doses (aluminium hydroxide, 125 mg and 12.5 mg/ kg. respectively). Corresponding experiments were carried out with 0.6% citric acid added to the antacid suspensions. Prostaglandin E2 (PGE2) in the gastric content was analysed by radioimmunoassay 6h after drug administration. Both high and low doses of aluminium hydroxide and Trigastril increased the concentration of PGE2 significantly. Citric acid did not significantly affect the antacid-induced PGE2 release except in combination with a low dose of aluminium hydroxide, with which a significant increase was seen. Release of PGE2 by low doses of antacids implies the possibility that enhanced cytoprotection may be involved in the mechanism by which antacids promote the healing of peptic ulcers.

Two pilot studies were performed to determine whether aluminium-containing antacids may have a place in the treatment of Helicobacter pylori infection. The urease activity of H. pylori is cytopathic to gastric epithelium, and inhibition of this enzyme may have therapeutic potential. In the first study 24 subjects, 12 of which were infected with H. pylori, were given 1 tablet of chewable aluminium hydroxide-containing antacids 10 min before a 14C-urea breath test. Gastric urease activity was suppressed by 33.3% (p = 0.02) in the H. pylori-positive subjects (none became negative) within 40 min after administration of the tablet. Gastric H. pylori infection can be effectively eradicated by triple regimens containing bismuth salts, tetracycline, and metronidazole. Owing to adverse effects of this treatment and concern for possible neurotoxicity of bismuth, a bismuth substitute is warranted. Hence, in the second study, 20 subjects infected with H. pylori were treated with 1 antacid tablet 4 times daily between meals, plus 500 mg oxytetracycline and 200 mg metronidazole 4 times daily with meals for 2 weeks. Individual H. pylori status was assessed by the 14C-urea breath test. Four weeks after cessation of treatment, H. pylori was eradicated in 45% (9 of 20) of the subjects (95% confidence interval, 23.1-68.5%). Thirty percent (6 of 20) observed one or more adverse effect regarded as moderate or severe, of which loose stools and headache were the most common. We conclude that the suppressive effect of antacids on gastric urease activity may be a mechanism by which aluminium-containing antacids promote peptic ulcer healing and that a low-dose regimen of antacids as a bismuth substitute in the triple treatment for H. pylori eradication is inferior to the triple treatment already established.

To elucidate possible new effects of antacids, gastric juice from 15 volunteers with known Helicobacter pylori status were analysed for eosinophil cationic protein (ECP), phospholipase A2 (PLA2) activity, phosphatidylcholine (PC), and bile acids (BA) before and after administration of one tablet of antacid or placebo in a double blind cross-over design. Geomtric mean ECP concentrations were more than 13 times higher in gastric juice from H. pylori-positive (12.9 μg/l) than from H. pylori-negative (0.97 μg/l) subjects (p = 0.0032). Geometric mean PLA2 activity was 1.31 U/l for the negative subjects and 4.02 U/l for the positive subjects (p = 0.13). There were no differences between positive and negative subjects with regard to either PC or BA concentration. Regardless of H. pylori status, mean PC concentration increased significantly after antacids as compared with placebo (p = 0.024). The effect of antacids did not differ significantly from placebo for ECP, PLA2 activity, or BA concentration. Hence, antacids may not act by binding 'toxic' H. pylori-associated gastric juice components like ECP or PLA2. Increased concentration of PC may indicate an increased protective capacity induced by antacids.

BACKGROUND: Helicobacter pylori gastritis may spread proximally in the stomach during profound acid inhibition. AIMS: To examine histological gastric body changes and epithelial cell proliferation before and after treatment with lansoprazole. PATIENTS AND METHODS: Patients diagnosed as having reflux oesophagitis grade 1 or 2 were enrolled and treated for 12 weeks with lansoprazole (30 mg every morning). After 12 weeks, 103 of the 118 patients appeared endoscopically healed and were asymptomatic; they then received maintenance treatment with 15 or 30 mg lansoprazole daily. Biopsy specimens obtained from similar sites before and after treatment, were available from 90 patients after a median of 64 weeks (range 15-73 weeks). Epithelial cell proliferation was determined by the number of Ki-67 antigen positive cells per gland. RESULTS: Of these 90 patients, 44 (49%) were found to be infected with H pylori. Their median inflammation score had increased from grade 1 before to grade 2 after treatment (p < 0.0001). Initially, the number of Ki-67 antigen positive cells per gland was significantly higher in the H pylori infected than in the uninfected group and increased further after treatment (p < 0.0001). In uninfected patients, no significant change in inflammation or proliferation occurred during treatment. CONCLUSIONS: A marked increase in body gastritis was observed in H pylori infected individuals during long term treatment with the proton pump inhibitor lansoprazole. Epithelial cell proliferation and atrophy also increased in infected but not in uninfected patients.

Bleeding from an induced gastric mucosal wound was monitored for 2 h in a rat model, in which normal hemostasis was disturbed mechanically by perfusing the lesion with saline. The hemorrhage was characterized by continuous bleeding and/or episodes of spontaneous rebleeding, as often seen in patients with gastric hemorrhage. The antifibrinolytic agent, tranexamic acid, significantly reduced total bleeding volume and number of rebleeding episodes, suggesting that plasmin-induced fibrinolysis might aggravate gastric mucosal hemorrhage.

The effect of physiological doses of guar gum (Guarem), 5 g. and fiber-enriched wheat bran (Fiberform), 10.5 g, on gastric emptying was studied by two different methods in healthy subjects: by a simple isotope localization monitor placed over the upper part of the abdomen and by gamma camera. The fiber preparations were added to a semisolid meal consisting of wheatmeal porridge and juice, using technetium-99 DTPA as a marker. The gamma camera showed no effect of fiber on gastric emptying. The isotope localization monitor, however, indicated that Fiberform prevented a postprandial accumulation of the meal within the upper part of the stomach. The simple isotope localization monitor cannot be recommended for measurements of gastric emptying.

Laparoscopic hepatobiliary surgery is a popular, blossoming procedure. As a consequence, a range of complications are seen, some of these are rare and not well known. As a tertiary center of hepatobiliary disease, we review our experiences with CT and MR imaging of a spectrum of complications after such surgery.

The aim of this study was to examine the lifestyle of adult patients with abdominal discomfort (i.e., diarrhea, bloating, pain, and irregular defecation) self-attributed to food hypersensitivity and compare it with controls to see if the patients had a special lifestyle explaining their symptoms. Forty-six participants in this study were adult ethnic Norwegians referred by general practitioners to the Centre for Occupational and Environmental Allergy at Haukeland University Hospital because of gastrointestinal complaints, which the patients or their doctors suspected could be due to food allergy. They were compared with 70 age- and sex-matched volunteer controls from the general population. All participants filled out an extensive questionnaire focusing on different lifestyle aspects.

The article presents a study about the verification of towed equipment for acquisition of seismic data. The execution of the analysis used to obtain proper design verification and the execution of the analysis of a seismic gun array are demonstrated. Also given are the challenges that need to be addressed in order to obtain an assessment of the system.

Finite element simulations of the Portevin-Le Chatelier effect in aluminium alloy 5083-H116 are presented and evaluated against existing experimental results. The constitutive model of McCormick (1988) for materials exhibiting negative steady-state strain-rate sensitivity is incorporated into an elastic-viscoplastic model for large plastic deformations and implemented in LS-DYNA for use with the explicit or implicit solver. Axisymmetric tensile specimens loaded at different strain rates are studied numerically, and it is shown that the model predicts the experimental behaviour with reasonable accuracy; including serrated yielding and propagating bands of localized plastic deformation along the gauge length of the specimen at intermediate strain rates.

AbstractThe paper presents the results from numerical simulations of bumper beam–longitudinal systems subjected to 40% offset impact loading. Numerical simulations were carried out with the non-linear finite element code LS-DYNA, searching for an efficient, numerically robust and accurate representation of the observed system behaviour. A comparative study of an industrial-like modelling procedure and another procedure incorporating a user-defined material model has been performed. In the latter procedure, the material model consists of state-of-the-art anisotropic plasticity, an isotropic strain and a strain-rate hardening rule as well as some ductile fracture criteria. Both shell and solid elements were utilized in discretizing the bumper beam–longitudinal set-up. Numerical crash results revealed good agreement with the experiments with respect to overall deformation mode and energy dissipation. The simulations were capable of giving relatively accurate prediction of the collapse mode found in the experimental tests, except for the bumper beam–longitudinal system with AA7003-T1 longitudinals. Sensitivity studies were performed considering both physical and numerical parameters. The physical parameters were strain-rate effects and the heat-affected zone, whereas the numerical parameter considered was adaptive meshing.

OBJECTIVE: To investigate effects of short-term oral treatment with seal oil in patients with psoriatic arthritis (PsA). METHODS: Forty-three patients with polyarticular PsA were randomized to receive oral treatment for 2 weeks with either seal oil or soy oil in a double blind controlled trial. Clinical and biochemical variables were assessed at baseline, after treatment, and 4 weeks post-treatment. Patients were allowed to continue nonsteroidal antiinflammatory drugs (NSAID) and disease modifying antirheumatic drugs (DMARD) during the study. RESULTS: Forty patients completed the study, 20 in each treatment group. Patients in the seal oil group reported a significant improvement in global assessment of the disease 4 weeks post- treatment (p < 0.01), and both groups showed a trend toward improvement in tender joint count, but the differences between the groups were not significant. There was a fall in the ratio of n-6 to n-3 fatty acids and in arachidonic acid (AA) to eicosapentaenoic acid (EPA) in serum after treatment with seal oil (p < 0.01). Twenty-one percent of all patients had elevated values of calprotectin in feces suggestive of asymptomatic colitis. CONCLUSION: Treatment with seal oil was followed by a modest improvement in patient's global assessment of the disease and a trend towards a decrease in number of tender joints. There was a shift in fatty acid composition in serum toward a putative antiinflammatory profile. Oral treatment with seal oil may have NSAID-like effects in PsA.

In a retrospective epidemiological study, 293 meningococcal disease patients hospitalized during 1985–2002, were examined for fatality and risk factors related to death. The overall case fatality rate (CFR) was 8·2%, but increased from 4% during 1985–1993 to 17% during 1994–2002. The latter 9-year period was characterized by more serogroup C infections and more patients with thrombocytopenia on admission to hospital. All patients categorized as meningitis on admission survived. Of the 24 patients who died, 21 had meningococcal skin rash on admission, 23 had an onset to admission time of 24 h, and 16 had severe septicaemia with hypotension and/or ecchymoses without meningitis on admission. By multivariate analyses, a short onset to admission time, >50 petechiae, thrombocytopenia and severe septicaemia on admission were associated with fatality. More lives could be saved through earlier admission to hospital. This can be achieved through more information to the public about the early signs of meningococcal septicaemia, with the recommendation to look for skin rash in patients with acute fever during the first day and night.

Twenty-eight healthy adult volunteers were immunized intranasally with an inactivated whole-virus influenza vaccine based on the strain A/New Caledonia/20/99 (H1N1), either in saline or mixed with formaldehyde-inactivated Bordetella pertussis as a mucosal adjuvant, or in a thixotropic vehicle with mucoadhesive properties. After four doses, all groups of vaccinees developed significant IgG- and IgA-antibody responses, measured by ELISA, in respectively serum and nasal secretions. None of the volunteers had demonstrable hemagglutination inhibition (HAI) antibodies in serum before being immunized, whereas more than 80% of them reached HAI titers ? 40, considered protective, after immunizations. In addition, cellular immune responses, measured as significant increases in CD4+ T-cell proliferation and granzyme B-producing cytotoxic T-cells, were detected against the vaccine strain as well as against heterologous virus strains (H3N2). However, no additive effect on these responses could be demonstrated with use of B. pertussis or the thixotropic substance in the present vaccines. It appeared, actually, that the mucoadhesive vehicle containing the thixotropic substance was less efficient than were the two other formulations. An influenza vaccine made as a simple particulate formulation of inactivated virus, and given repeatedly onto the nasal mucosa, may thus be an attractive alternative to currently available vaccines.

Abstract: We investigated the effect of prior acute stress on colonic permeability induced by a chemical irritant known to induce symptoms similar to inflammatory bowel disease in rodents. Adult male rats (n=12) were stressed by a single session of ten unpredictable, uncontrollable foot shocks, and half were home cage controls (n=12). Twenty-nine days later, half of each treatment group was exposed to 4% DSS (dextran sulphate sodium) solution in their drinking water for 48 hours while half received pure water over two periods separated by 17 days. After food deprivation overnight and light isoflurane anaesthesia the following morning, the animals were given a colonic infusion of 2000 nCi (nanocurie)51CrEDTA (51Cr-labelled ethylenediaminetetraacetic acid) and then placed individually in metabolic cages for a six hours continuous urine collection. Radioactivity in urine was measured by a gamma counter and percentage recovery of51CrEDTA calculated as an indicator of colonic mucosal permeability. Results concluded that pre-shocked animals exposed to DSS showed significantly higher mucosal permeability than the pre-shocked animals given water, and the non-shocked animals given either DSS or water. Pre-shock in combination with two exposures to a chemical irritant separated by 17 days had a pronounced effect on colonic permeability, indicating that stress should be considered a possible initiating or contributory factor to increased intestinal permeability related to a mucosal challenge.

Inhalation of antigens may stimulate the immune system by way of the upper as well as the lower airways. We have shown that at least 1,000 times more live pneumococci were recovered from pulmonary tissue after being presented as drops of a liquid suspension onto the nares of anesthetized mice compared to the number of bacteria recovered from animals that were not anesthetized in the course of the challenge. Mice that were similarly immunized intranasally by inhalation of three different nonreplicating particulate vaccine formulations, i.e., a meningococcal outer membrane vesicle (OMV) vaccine, a formalin-inactivated whole-virus influenza (INV) vaccine, and the INV vaccine with OMVs as a mucosal adjuvant, during general intravenous anesthesia developed concentrations of vaccine-specific serum immunoglobulin G (IgG) antibodies that were four to nine times higher than in mice that were fully awake during immunizations. The concentrations of IgA antibodies in serum were also higher in anesthetized than in nonanesthetized mice and correlated positively with the corresponding levels of serum IgG antibodies in the anesthetized but not in the nonanesthetized mice. In saliva and feces, however, the concentrations of IgA antibodies were equally high whether or not the animals were dormant during immunizations. The results indicate that intrapulmonary antigen presentation, as a part of an intranasal immunization strategy, is of importance for systemic but not for mucosal antibody responses. A major portion of IgA antibodies in serum may thus be derived from nonmucosal sites.

BACKGROUND AND AIMS: Our aim was to study intragastric volume and distribution of a liquid meal in patients with reflux oesophagitis using three dimensional ultrasonography. METHODS: Twenty patients and 20 healthy controls underwent ultrasonographic measurements of the stomach using a position sensor based on magnetic scanhead tracking for acquisition of three dimensional images. In vivo accuracy of the method was evaluated by scanning a soup filled barostat bag positioned in the proximal stomach of six healthy subjects. RESULTS: In the volume range 100-700 ml, our three dimensional system showed excellent correlation (r=0.99) between estimated and true volumes (limits of agreement -3.4 to 11.0 ml) and a low interobserver variation (limits of agreement -10.9 to 6.7 ml). After ingestion of a 500 ml meat soup meal, patients with reflux oesophagitis revealed a larger volume of the total and proximal stomach at two and 10 minutes (p=0.05; p=0.01, respectively), and an increased proximal/distal intragastric volume ratio at 10 minutes (p=0.04). Patients also experienced more epigastric fullness than controls (p=0.0006). CONCLUSIONS: The present three dimensional ultrasound system showed excellent agreement with true volumes and low interobserver variation. Soon after a liquid meal, patients with reflux oesophagitis have abnormal pooling of the ingested liquid in the proximal stomach.

A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal. After an overnight fast, 20 patients with recurrent abdominal pain (age, 7–14 years) and 23 healthy control subjects (age, 7–13 years), were scanned by a 5‐MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup. Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P= 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P= 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects. The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.

OBJECTIVE: To compare the effects and tolerability of omeprazole and cisapride with that of placebo for control of heartburn in primary care patients. DESIGN: Randomised, double blind, placebo controlled study. Setting: 65 primary care practices in Norway. PARTICIPANTS: 483 untreated patients with complaints of heartburn >/=3 days a week, with at most grade 1 reflux oesophagitis. INTERVENTIONS: Omeprazole 20 mg once daily, cisapride 20 mg twice daily, or placebo for 8 weeks. MAIN OUTCOME MEASURES: Adequate control of heartburn, defined as &lt;/=1 day of the past 7 days with no more than mild heartburn, after 4 weeks of treatment. RESULTS: In the all patients treated analysis, adequate control of heartburn was achieved in 71% of patients taking omeprazole, 22% taking cisapride, and 18% taking placebo after 4 weeks of treatment (omeprazole v cisapride and placebo, P&lt;0.0001; cisapride v placebo, non-significant). Results were comparable in patients with or without reflux oesophagitis. In patients treated with omeprazole only, symptom control was achieved significantly more often in patients positive for Helicobacter pylori. Antacid use was 2-3 times greater in patients taking cisapride or placebo than in those taking omeprazole. Relief of non-reflux symptoms did not significantly differ between the three groups. Significantly more patients taking cisapride reported adverse events than those taking omeprazole or placebo. CONCLUSIONS: Omeprazole 20 mg once daily was highly effective in relieving heartburn whereas cisapride 20 mg twice daily was not significantly more effective than placebo.

Immunoglobulin A and IgM are subjected to epithelial transport only when they are produced as polymers with incorporated J chain. Immunocytes containing various Ig isotypes and associated J chain in gastric mucosa, as well as IgA-degrading protease activity in Helicobacter pyloricultures, were examined. Gastric body specimens from 15 H. pylori-positive and 14 H. pylori-negative patients were studied by paired immunofluorescence for IgA, IgA1, IgA2, IgG, or IgM and concurrent cellular J chain. H. pyloriisolates were incubated with IgA1 or secretory IgA and examined by immunoelectrophoresis for cleavage products. A substantial increase of Ig-producing cells occurred in chronic gastritis, particularly in the IgA1 isotype, but H. pyloriwas shown to possess neither IgA1-specific nor nonspecific IgA-degrading protease activity. Regardless of infection status, reduced J chain expression was observed for all immunocyte isotypes (except for IgM) in inflamed compared with normal gastric body mucosa, the median positivity for IgA1 cells being reduced to 58.7%versus87.9% (P= 0.0002), and for IgA2 cells to 48.9%versus87.8% (P= 0.0002). This down-regulation of the J chain suggested that a large fraction of IgA monomers is produced in gastritis.

This review discusses the problem of deep vein thrombosis (DVT) after operation and identifies three levels of risk of DVT: low (< 10 per cent), moderate (10–40 per cent) and high (40–80 per cent). Special emphasis is placed on the most recent prophylactic treatment, low molecular weight heparins (LMWHs), particularly enoxaparin. Several LMWHs are now available, but they difer slightly and each must be evaluated on its own merits. In general, however, LMWHs are both efective and safe in those patients at moderate or high risk of DVT. Thromboprophylaxis is cost effective when analysed using healtheconomic methodology.