[Helicobacter pylori infection and a decrease in the pH of gastric juice as a possible cause of bleeding in erosive gastritis]

INTRODUCTION

Bleeding erosive gastritis and ulcer disease are the most common causes of bleeding from the upper parts of the alimentary tract. Over the period of the last 10 years there has been an increased number of patients where Helicobacter pylori is mentioned as the possible cause of infection. At the same time in this group of patients pH values were decreased. During our research we wanted to examine the influence of local pH value and Helicobacter pylori infection on the occurrence of bleeding erosive gastritis.

MATERIAL AND METHODS

During this research we examined two groups of patients. The following parameters were examined within these two groups of patients: 1. presence of Helicobacter pylori infection; 2. histopathologic changes in mucus; 3. there were 57 patients with a bleeding form of gastritis of unknown etiology, whereas the second group consisted of 351 patients with non-bleeding form of gastritis. We examined the localization: 4. local pH.

RESULTS

The presence of Helicobacter pylori infection is statistically significantly higher in the group of patients with bleeding gastritis, when compared to the non-bleeding group (72%:57%). Within the Helicobacter positive patients the most common change of mucose (over 90%) is active chronic gastritis. The presence of erosions and histopathological changes characteristic for Helicobacter pylori infection coincides with colonization of Helicobacter in the antrum. The pathogenetic action of bacteria in antrum decreases the local pH. Therefore the lowest value of local pH occurred in the group of bleeding Helicobacter pylori positive gastritis (1.72).

DISCUSSION

Results of this research helped us in treatment of helicobacter pylori positive patients making a risk group for development of recurrent bleeding. We accomplished therapeutical effect in 80% of patients by using a three component eradication therapeutic protocol for helicobacter pylori. Within the group of patients who have been cured, regression of histopathological changes occurred and increase of local pH took place. In the group with persistent infection we have come across with high percentage of recurrent bleeding (37.5%).

CONCLUSION

In our opinion helicobaceter pylori infection and decrease of local pH, which take place during the reaction of mucose on the presence of infection, are very aggressive factors which can cause bleeding erosions.

[Risk factors in the development of bleeding peptic ulcer]

INTRODUCTION

Gastric or duodenal peptic ulcer is the most common cause of bleeding from upper parts of the alimentary tract. Although there is a great number of these patients in the clinical practice, there are some contradictory characteristics in regard to the age of patient, localization of ulcer, the diameter of ulcer and Helicobacter pylori infection as possible risk factors in development of bleeding peptic ulcer. The aim of this work is evaluation of risk factors in our patients.

MATERIAL AND METHODS

During this research we examened two groups of patients: a) first group consisted of patients with acute gastric or duodenal bleeding peptic ulcer, b) the second group consisted of patients without peptic ulcer bleeding. In both groups of patients we examined the most common risk factors for development of bleeding. This research took place in the Clinic for Surgery "Dr Dragisa Misović" in the period from January to December 1997.

RESULTS

In both groups we had male predominance. Patients with bleeding peptic ulcers are statistically older when compared with the non-bleeding group (52.2 +/- 7.3:65.3 +/- 8.1). In both groups the anterior wall of the duodenum is the most common localization. In the group of bleeding ulcers we had high frequency of patients with localization of ulcers in the back wall of the duodenal bulb (20%). In this group of patients there was a high percentage of penetrating ulcers (62.5%) with active arterial bleeding (Forrest I a). Ulcers on the front wall of duodenal bulb and in small bend of stomach, as most common (over 50%), gave small peptic ulcers (under l cm) with capillary bleeding (oozing-Forrest I b) without haemodynamic complications. The presence of Helicobacter pylori infection is statistically significantly higher in the group of patients with bleeding peptic ulcers.

DISCUSSION

The age of patients and localization of ulcer are very important and well known risk factors for development of bleeding peptic ulcer. However, in the last ten years Helicobacter pylori infection has become one of the most important risk factors. All Helicobacter pylori positive patients were treated with three component eradicational therapy for Helicobacter pylori. In this way we restricted the number of recurrent bleeding.

CONCLUSION

In our opinion the age of patient, localization of ulcer, diameter and Helicobacter pylori infection are very important risk factors for development of bleeding peptic ulcer.

[Anticardiolipin antibodies in patients with ischemic brain disease]

Anticardiolipin antibodies are best defined antiphospholipid antibodies and a recently described marker of increased risk for ischemic brain disease. Investigations were performed in 151 patients with ischemic brain disease in order to determine the occurrence of anticardiolipin antibodies and define the clinical characteristics of patients with an increased titer of anticardiolipin antibodies. Measurement of anticardiolipin antibody titer was performed by immunoenzyme method. Besides, analyses of certain tests indicative for blood coagulative properties were also done. In addition, the occurrence of anticardiolipin antibodies was investigated in 49 patients with other non-immune neurological diseases and disorders. Control sera were obtained from 50 healthy subjects and 6 patients with senile cataract. Investigation showed the increase of anticardiolipin antibody titer in 22.8% of the patients with ischemic brain disease (30% with transient ischemic attacks, 19% with brain infarction) and in 4% of the patients with other neurological disorders of non-immunological genesis. The patients with increased titer of anticardiolipin antibodies suffered more frequently from recurrent forms of ischemic brain disease, all of them were below 50, and they had less risk factors for atherosclerosis and ischemic brain disease. It was concluded that the presence of increased titer of anticardiolipin antibodies in younger patients with recurrent forms of ischemic brain disease and less risk factors could be the marker of the increased risk for ischemic brain disease.

[Sensitivity of atherosclerosis indices in patients with ischemic brain disease]

Epidemiological studies suggest that dyslipoproteinemias and hyperlipoproteinemias present one of the most important risk factors in the development of atherosclerosis and its complications. The aim of this study was to find out which of the lipid status disorders in patients with ischemic brain disease was the most important risk factor in the development of cerebral atherosclerosis. Patients with ischemic brain disease were examined in the acute and subacute phase. Total blood cholesterol, low density lipoproteins (LDL) and high density lipoproteins (HDL) as well as of apolipoproteins A1 and B were determined. Correlations (atherogenic indices) of some lipid components with the severity of clinical course and echo-angiographic finding were determined. It was concluded that the highest correlation with the cerebral atherosclerosis severity degree existed with the level of apoA1 and apoB apolipoproteins, followed by correlation of LDL and HDL cholesterol, and the lowest correlation was found between HDL and the total cholesterol. Accordingly, apolipoproteins, i.e., apoA1/apoB indices are the most sensitive markers of the risk for atherogenesis.

[Sensitivity of electrophysiologic tests in the diagnosis of carpal tunnel syndrome]

According to anatomic characteristics of median nerve branches and pathophysiological basis of the carpal tunnel syndrome (CTS), significant difference in sensitivity of some electrophysiological parameters in the diagnosis of this syndrome was presumed. The aim of this study was to analyze characteristics of some abnormalities of electrophysiological parameters and to determine their frequency in the carpal tunnel syndrome. Investigation was performed on 34 patients with the carpal tunnel syndrome and 30 neurologically healthy subjects. EMGs of the tenar muscles, terminal latency parameters for the median nerve and sensory conductivity of the median nerve branches including cutaneous palmar branch and ulnar nerve branches of the ring finger were examined and analyzed. Results have shown that abnormalities were most frequently found in sensory conductivity parameters for median nerve branch of the ring finger. Significant difference between sensory conductivity parameters for cutaneous palmar branch and median nerve branch of the thumb was also found. These results were discussed in terms of current knowledge about anatomic characteristics of the hand innervation and pathophysiology of the carpal tunnel syndrome. It was concluded that the most frequent physiological findings could be used as a highly sensitive test for reliable and early diagnosis of CTS.

[The effect of therapeutic plasma exchange on serum immunoglobulins and the clinical course of myasthenia gravis]

Fourteen patients with clinically, pharmacologically and electrophysiologically confirmed myasthenia gravis in which therapeutic plasma exchange was performed were analyzed. Condition of these patients was assessed before and after the plasma exchange using the Besinger score. The serum immunoglobulin levels were also determined by ELISA-test before and after the plasma exchange. Findings have shown that clinical improvement was highly significant. Changes in IgM and IgA levels were significant, but not in IG and IgE. Significant correlation neither between the level of each separate immunoglobulin and clinical condition of the patient, nor between the change in the level of each separate immunoglobulin and changed clinical course was found after the series of plasma exchange. Cumulative effect of all immunoglobulins was not observed due to differences in their physical and chemical properties. Absence of significant statistical correlation between the level of each immunoglobulin and clinical condition of the patient as well as between the level changes of each separate immunoglobulin and changed clinical condition after series of plasma exchange could be explained by cumulative effect of all immunoglobulins, but probably also by the presence of some other, circulating factor not belonging to the class of immunoglobulins and associated with the development of myasthenic weakness.

Circadian variations of platelet aggregability and fibrinolytic activity in patients with ischemic stroke

The purpose of this study was to determine circadian dynamics of platelet aggregability and fibrinolytic activity in patients with ischemic stroke. The study was carried out in 21 male patients, aged from 51 to 65 years in acute phase of severe hemispheric brain infarction diagnosed clinically and radiologically. The examinations showed that circadian variations of platelet aggregability and fibrinolytic activity were persistent, but the intervals and the degree of oscillation differed from those in healthy persons. The significance of these disorders for clinical purposes was discussed.

[Tetrazepam in the treatment of painful muscle spasms]

The aim of the study was to examine myorelaxant and analgetic effects of tetrazepam using double-blind controlled random tests. The study comprised two groups of patients with 30 subjects in each with reflex muscle spasms in the lumbar and cervical spine. One group was treated with a nonsteroid analgetic and the another one with the combination of tetrazepam and a nonsteroid analgetic. The treatment lasted 15 days and the assessment using the standardized, graded scale was performed 0, 7 and 15 days after the onset of the treatment. More hematologic and biochemical parameters were analysed both at the beginning and completion of the treatment. The results of the study have shown that the combination of nonsteroid analgetics and tetrazepam achieved better and faster effects on pain and muscle spasms compared to nonsteroid analgetics with no significant side effects.

[Treatment of peripheral paresis-paralysis of the facial nerve using corticosteroids]

The study comprised 113 patients with Bell's paresis-paralysis of the facial nerve. This group was considered as experimental while the control group involved patients with the same disease treated with oral corticosteroids. In both groups physical therapy has been applied from the very beginning of therapy. The results of the study have shown that in the group of patients treated with local corticosteroids the complete recovery was found in 82% of cases, partial in 14% and no signs of recovery in 4%. The mean time of clinical and electrophysiologic recovery was 17 days. In the control group of patients the complete recovery was found in 50%, partial in 37.5% and no improvement in 12.5%. The significant influence on the time and degree of recovery in both groups, and especially in the first group, has the time of starting the therapy; if the therapy started in the first week after the onset of the disease, the recovery was usually complete in the first group.

[Immunochemical findings in the cerebrospinal fluid in patients with inflammatory demyelinating polyradiculoneuropathy]

The aim of the study was to check the hypothesis of involvement of the structure of the central nervous system on the basis of the analysis of the integrity of blood-brain barrier and the degree of IgG synthesis in the intrathecal space of patients with inflammatory demyelinization polyradiculoneuropathy. The study involved 27 patients with acute and 14 patients with chronic inflammatory demyelinization polyradiculoneuropathy. The analysis of liquor was performed in different stages of the disease. The results have shown that in the acute phase, in the phase of the maximal functional deficit there are signs of damaged integrity of the blood-brain barrier but without signs of increased intrathecal IgG synthesis. It has been concluded that there are no reliable signs of increased immunologic activity in the intrathecal space of patients with inflammatory demyelinization polyradiculoneuropathy.

[Subfractions of high-density cholesterol lipoproteins in patients with ischemic cerebrovascular disorders]

Aiming to detect the most sensitive markers of increased risk of ischemic cerebrovascular diseases HDL, HDL2 and HDL3 cholesterol levels were examined using the ultracentrifugation method in 36 patients with acute brain infarction and 34 healthy subjects of the control group. The results of the study have shown significant reduction of the total HDL cholesterol levels in both subfractions, and especially of HDL3 in patients with brain infarction. This finding was discussed in the light of recent studies of lipid disorders in patients with ischemic cerebrovascular diseases. It has been concluded that further studies of these diseases should be directed toward apolipoproteins.

[Abortion at 10 to 12 weeks using a plastic syringe or electric aspirator]

The study included 170 women subjected to menstrual regulation. The double-valve band syringe was used in 96 and the electric pump (the vacuum source usually used at the Department) in 74 cases. Nearly all the procedures were performed under general anesthesia, using 8 mm, 10 mm or 12 mm plastic rigid cannulae. Three abortions with the hand syringe also required dilatation and curettage, and all three women suffered blood loss exceeding 100 ml. There was one cervical laceration surgically repaired and a case of adnexitis reported among the hand syringe group. Immediate complications occurred in 7.3% of the cases using the hand syringe and in 4.1% of using the electric pump. The mean procedural time was 4.2 minutes and 4.0 minutes, respectively, with the hand syringe and the electric pump. Only three women reported complications or complaints at the follow-up visit, all of them from the electric pump group.

[Bacteriological examination of seminal fluid in infertile men]

Presented are the results of bacteriologically examined ejaculates from 113 patients who had never had any symptoms of inflammation in the genital tract region. In 40.7% of them Staphylococcus epidermidis was found in the ejaculate next to other bacteria meant to be the cause of the inflammation of the genital tract in men. A comparison was made of the bacteria in the urine voided before ejaculation and in the cervix and vagina of the patients' views with the species in the semen.

[Laparoscopic sterilization using tubal rings and clips]

From 1978 to April 1980, 36 laparoscopic sterilization procedures were completed at the Gynecological Department in Maribor. For tubal occlusion in 16 cases Tupla clips and in 20 cases the Tubal Falope ring were used. It appears that the incidence of complications and other technical difficulties is somewhat more frequent with clips. There have been no pregnancies in all these cases.

[Diagnosis of breast cancer (author's transl)]

The authors draw attention to the frequency of breast carcinoma and the importance of its early detection. They critically evaluate the advantages and disadvantages of X-ray diagnosis, thermography, ultrasound, radioisotope diagnosis, cytology, and histological diagnosis.