News - Part 70

Human gastric mucosal hydrophobicity and Helicobacter pylori infection: Contact angle measurement

The fresh biopsy on the glass slide was placed on the goniometer stage and a 0.5 ^l drop of 0.9% saline deposited from a 0.2 mL microsyringe (Gilmont instruments, GS-1100, USA). Droplets were illuminated by a sodium lamp and imaged with a zoom lens (Navitar Inc, USA) coupled via an extension tube to a charge-coupled device camera (Hamamatsu C3077, Hamamatsu Photonics Ltd, United Kingdom). The picture of the drop on the biopsy surface was then captured by the camera and transferred to the computer, where the sides of the drop were magnified and the angle readings taken at a high magnification. Read more »

Advances in the diagnosis and management of toxic megacolon (Part 5)

However, the blowhole decompression procedure is performed only rarely and the reported experience with this procedure is, therefore, limited to a few centres. Looking to the future, the authors noted that NO levels are increased in cases of TM, and this may represent a key pathway driving the toxic dilation. Recent work suggests that the suppression of NO production may be the reason why corticosteroids are effective in IBD-related cases of TM . Read more »

Human gastric mucosal hydrophobicity and Helicobacter pylori infection: Methods

hydrophobicityH pylori infection was assessed by histology, culture and PCR. Patients were considered to be H pylori-positive if two or more of the above tests were positive.

Identification of the H pylori cagA+ strain was carried out by PCR using two pairs of primers: cagA (primer 1: 5′-CTC AAA TCC CCC TTA CCA AAC TC-3′; primer 2: 5′-GAG ATT AAG GAT TTC CAA AAA GAC TCT AA-3′, product size 130 base pairs) and urease C (primer 1: 5′-ATA AGG TGG CTC CGG TCG TT-3′; primer 2: 5′-TGG CTC AAT TGG TTA GGG TGT-3′, product size 120 base pairs), synthesized by Dr F Lewis (University of Leeds). Read more »

Advances in the diagnosis and management of toxic megacolon (Part 4)

Some physicians are comfortable managing persistent megacolon for up to seven days in patients with no overt signs of perforation or worsening toxicity. Practically, the decision to proceed with surgery is almost certainly made on a case-by-case basis with a view to the patient’s present condition and comorbidities. It is important to note that, if missed, mortality from perforation is 40%, as opposed to 8% or less if surgery is performed in a more controlled setting. Read more »

Human gastric mucosal hydrophobicity and Helicobacter pylori infection: Subjects

One hundred patients were randomly recruited from endoscopy clinics in the North of England without prior knowledge of their H pylori status. The study was approved by the Leeds Health Authority clinical research ethics committee and the York research ethics committee. Written consent was obtained from and information sheets given to each patient. Patients were included in the study if they were not taking acid suppressive drugs, nonsteroidal anti-inflammatory drugs or receiving treatment for H pylori, Read more »

Advances in the diagnosis and management of toxic megacolon (Part 3)

IBD-related casesThey were able to find only a single, small prospective study that identified gastric and small bowel distension as a significant predictor of a poor outcome in TM. Based on this review, we would emphasize the importance of a global assessment, including serial clinical examinations, laboratory tests and abdominal radiographs, when considering a diagnosis of TM. We would further recommend that all patients at risk for TM, even those with signs of only mild toxicity, should undergo a CT scan performed upon admission to identify possible complications. Read more »

Human gastric mucosal hydrophobicity and Helicobacter pylori infection

endoscopic antral biopsy samplesThe hydrophobic or water-repellent mucus lining of the stomach plays an important role in protecting the gastric mucosa from acid and peptic digestion . In 1983, it was reported that canine gastric mucosa has clear hydrophobic properties as determined by contact angle analysis. Since this observation, reports from many investigators have indicated that the stomach of all mammalian species tested, including humans, have nonwettable properties that appear to be attributable to the hydrophobic characteristics of the overlying mucus gel layer. Read more »

Advances in the diagnosis and management of toxic megacolon (Part 2)

To diagnose TM, the physician must rely on a combination of clinical criteria and radiographical evidence of dilation, as described by Jalan et al in 1969 . Gan and Beck outline the limited data to support the use of CT or other techniques for the diagnosis of TM. We discovered an article, written since their review was published, that examined the utility of ultrasound as a primary diagnostic tool in a small number of patients with TM . The limited use of radiographical techniques may be due to our incomplete understanding of the pathophysiology of this disease. Read more »

Benzocaine-induced methemoglobinemia: Discussion (Part 4)

The other classic clinical finding is chocolate brown arterial blood, again seen in both patients. The blood fails to change colour when exposed to supplemental O2 or when a drop is placed on filter paper . This bedside maneuver is a quick and accurate test to differentiate cyanosis due to other causes than from MHg formation, because exposure of blood to a stream of O2 will turn the arterial blood bright red in cases of cyanosis not associated with methemoglobinemia. Read more »

Advances in the diagnosis and management of toxic megacolon (Part 1)

toxic megacolonFor 50 years, researchers and clinicians have studied the causes, pathophysiology and treatment of toxic megacolon (TM), and Gan and Beck summarized these efforts in their review. Patients diagnosed with TM are faced with a possibly fatal condition that may require intensive care and a prolonged hospital stay. Certainly the varied causes of TM are now well documented, but most physicians associate TM with fulminant IBD. In addition to reviewing the incidence of TM in IBD, the authors described the changing epidemiology of this disease. Read more »

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