bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helicobacter pylori ‘rescue’ regimen when proton pump inhibitor‐based triple therapies fail
Authors: Gisbert J. P. , Pajares J. M. 
Published: March 2003

SummaryEven with the currently most effective treatment regimens, about 10–20% of patients will fail to obtain eradication of Helicobacter pylori infection. Therefore, in designing a treatment strategy, we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate.The choice of second‐line treatment depends on which treatment was used initially, as re‐treatment with the same regimen is not recommended. Therefore, it is not necessary to perform culture after the first eradication failure. Assessment of the sensitivity of H. pylori to antibiotics only after failure of the second treatment is suggested in clinical practice.Different possibilities of empirical treatment have been suggested. After failure of proton pump inhibitor–amoxicillin–clarithromycin, quadruple therapy has generally been used. More recently, replacement of the proton pump inhibitor and the bismuth compound by ranitidine bismuth citrate has also achieved good results. After proton pump inhibitor–amoxicillin–nitroimidazole failure, re‐treatment with proton pump inhibitor–amoxicillin–clarithromycin has been proven to be effective. Finally, first‐line treatment should not combine clarithromycin and metronidazole in the same regimen, because of the problem of resistance to both antibiotics.Recently, rifabutin‐based rescue therapies have been shown to constitute an encouraging strategy for eradication failures, as they are effective against H. pylori strains resistant to antibiotics.
Genetic testing and counselling for hereditary colorectal cancer
Authors: Trimbath J. D. , Giardiello F. M. 
Published: March 2003

SummaryColorectal cancer is the second leading cause of cancer death, after lung cancer, in the USA. The great majority (80%) of patients with colorectal cancer have sporadic disease with no evidence of having inherited the disorder. In the remaining 20%, a potentially definable genetic component exists. With the discovery of gene mutations related to hereditary colorectal cancer, risk assessment based on genetic test results is now feasible. The following review focuses on the two well‐described colorectal cancer genetic syndromes—familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, the process of genetic counselling, currently available genetic tests, and indications for their use.
Immunopathogenetic and therapeutic aspects of autoimmune hepatitis
Authors: Medina J. , García‐Buey L. , Moreno‐Otero R. 
Published: March 2003

SummaryAutoimmune hepatitis is a chronic, progressive liver disease that responds well to immunosuppressive therapy, but has a poor prognosis if untreated. Possible triggering factors include viruses, other autoimmune disorders and drugs. The molecular mechanisms contributing to the pathogenesis include: reactions of autoantibodies against their corresponding autoantigens; aberrant expression of histocompatibility antigen class I and II molecules, cell adhesion molecules and cytokines; increased oxidative stress; and the occurrence of angiogenesis. The prevalence of the disease is highest in Caucasians, Europeans and women. The natural history of autoimmune hepatitis shows a poor prognosis, with frequent progression to cirrhosis and hepatic insufficiency in untreated patients. The occurrence of hepatocellular carcinoma is rare and is found only in long‐standing cirrhosis. Corticosteroids as monotherapy or in combination with azathioprine are the treatments of choice; different therapeutic schedules and particularities of treatment for pregnant women and children have been established. To avoid treatment‐associated adverse effects, alternative therapies have been proposed, including ciclosporin, budesonide, tacrolimus, mycophenolate mofetil, ursodeoxycholic acid, methotrexate, cyclophosphamide, mercaptopurine and free radical scavengers. Liver transplantation is indicated for patients refractory to or intolerant of immunosuppressive therapy.
Psychiatry, psychotherapy and gastroenterology — bringing it all together
Authors: Stern J. M. 
Published: March 2003

SummaryIn this review, some aspects of functional gastrointestinal disorders are described, with particular reference to psychiatric and psychological features. Seven syndromes or conditions, which may present not uncommonly in a gastroenterology clinic, are identified and clarified. Thereafter, the roles of a psychiatrist and other mental health professionals (psychotherapists, psychologists) within gastroenterology are described, with particular reference to what an integrated service may offer.
Effective intra‐oesophageal acid suppression in patients with gastro‐oesophageal reflux disease: lansoprazole vs. pantoprazole
Authors: Frazzoni M. , De Micheli E. , Grisendi A. , Savarino V. 
Published: March 2003

SummaryBackground : Effective intra‐oesophageal acid suppression is an important therapeutic goal in complicated and atypical gastro‐oesophageal reflux disease.Aim : To compare the efficacy of lansoprazole and pantoprazole in normalizing oesophageal acid exposure.Methods : Fifty patients with complicated or atypical gastro‐oesophageal reflux disease were randomly assigned to receive 30 mg lansoprazole (n = 26) or 40 mg pantoprazole (n = 24) once daily. Three to four weeks after the start of treatment, patients underwent 24‐h oesophageal pH monitoring whilst on therapy. If the results were improved but still abnormal, the dosage was doubled and pH monitoring was repeated. If oesophageal acid exposure was not improved, the patient was shifted to the alternative drug regimen.Results : Oesophageal acid exposure was normalized in all 26 patients treated with lansoprazole (in 35% of cases with a double daily dosage), whereas in six of the 24 (25%) patients treated with pantoprazole it was neither normalized nor lowered (P = 0.008). Accordingly, the mean percentage acid reflux time was significantly lower for the lansoprazole group (2.1) than for the pantoprazole group (5.8) (P = 0.032).Conclusions : Effective intra‐oesophageal acid suppression can be accomplished more reliably with lansoprazole than with pantoprazole in patients with complicated and atypical gastro‐oesophageal reflux disease.
Occurrence of peptic ulcer disease in connective tissue disease patients associated with xerostomia
Authors: Luo J.‐C. , Lin H.‐Y. , Chang F.‐Y. , Lu R.‐H. , Lu C.‐L. , Chen C.‐Y. , Lee S.‐D. 
Published: March 2003

SummaryBackground : Saliva plays a role in mucosal protection and ulcer healing.Aim : To study whether decreased salivary production leads to peptic ulcer disease in connective tissue disease patients associated with xerostomia.Patients and methods : Two hundred and two connective tissue disease patients (90 with xerostomia and 112 without xerostomia) were enrolled. Their demographic data and use of medications were recorded. Peptic ulcer disease was confirmed by endoscopy. The stimulated salivary output and secretory epidermal growth factor level were measured.Results : Compared with non‐xerostomic counterparts, xerostomic patients manifested a higher occurrence of peptic ulcer disease (31% vs. 12%, P = 0.001), lower stimulated salivary output (9.3 ± 4.1 vs. 22.9 ± 5.9 mL/15 min, P < 0.001) and lower stimulated salivary epidermal growth factor output (1.40 ± 0.77 vs. 3.00 ± 0.96 ng/min, P < 0.001). Multivariate analysis disclosed that an older age (≥ 60 years) (odds ratio, 4.71; P < 0.001), xerostomia with stimulated salivary output of ≤1 mL/min (odds ratio, 7.54; P = 0.014) and the use of non‐steroidal anti‐inflammatory drugs (odds ratio, 5.76; P = 0.031) were the risk factors leading to peptic ulcer disease. In addition, xerostomic connective tissue disease patients receiving non‐steroidal anti‐inflammatory drugs manifested an extremely high risk of development of peptic ulcer disease (odds ratio, 19.78; P < 0.001).Conclusions : Ageing, the use of non‐steroidal anti‐inflammatory drugs and poor salivary function are potential risk factors for the development of peptic ulcer disease in patients with connective tissue disease. If these xerostomic subjects consume non‐steroidal anti‐inflammatory drugs, they will encounter an extremely high peptic ulcer disease risk.
Circadian pattern of intragastric acidity in patients with non‐erosive reflux disease (NERD)
Authors: Zentilin P. , Dulbecco P. , Bilardi C. , Gambaro C. , Iiritano E. , Biagini R. , Mela G. S. , Tessieri L. , Mele M. R. , Mansi C. , Pandolfo N. , Vigneri S. , Savarino V. 
Published: March 2003

SummaryBackground : Most patients with gastro‐oesophageal reflux disease have non‐erosive reflux disease. Proton pump inhibitors are less effective than expected in these patients, but no previous study has measured their 24‐h gastric pH values.Aims : To evaluate whether there are differences in 24‐h intragastric acidity between reflux patients with and without oesophagitis and controls. The influence of Helicobacter pylori on the gastric pH of reflux patients was also assessed.Methods : Sixty‐three consecutive patients with gastro‐oesophageal reflux disease symptoms who agreed to undergo endoscopy and 24‐h pH‐metry were recruited. Twenty‐five (39%) had erosive oesophagitis and 38 (61%) did not. H. pylori was diagnosed by CLO test, histology and 13C‐urea breath test. Gastric pH was also measured in 30 controls without digestive symptoms.Results : H. pylori was found in seven of the 25 (28%) patients with oesophagitis and 14 of the 38 (37%) patients with non‐erosive reflux disease. Oesophageal pH‐metry was abnormal in 21 of the 25 (84%) patients with oesophagitis and in 32 of the 38 (84%) patients with non‐erosive reflux disease. The median gastric pH did not differ between patients with and without oesophagitis or between them and controls during the 24 h (P = 0.8) and other time intervals (P = 0.2–0.4). The gastric pH did not differ between infected and non‐infected patients with oesophagitis (P = 0.2–0.4) or non‐erosive reflux disease (P = 0.3–0.8).Conclusions : The circadian pattern of intragastric acidity does not differ between patients with non‐erosive reflux disease and oesophagitis. Moreover, the study confirms that H. pylori infection does not affect the gastric pH in either group of reflux patients.
Moderate coffee consumption increases plasma glutathione but not homocysteine in healthy subjects
Authors: Esposito F. , Morisco F. , Verde V. , Ritieni A. , Alezio A. , Caporaso N. , Fogliano V. 
Published: March 2003

SummaryBackground : The consumption of unfiltered coffee, containing bioactive diterpenes, causes an increase in plasma homocysteine concentration. A slight increase in plasma homocysteine is also caused by large quantities of filtered coffee. Coffee terpenes also raise plasma glutathione in mice.Aim : To verify the effect of Italian‐style coffee consumption on the plasma concentration of glutathione and homocysteine in healthy subjects.Methods : Twenty‐two volunteers consumed five cups of coffee per day for 1 week and maintained their usual diet. Five subjects were enrolled as controls. The intervention trial was preceded and followed by seven coffee‐free days.Results : Plasma glutathione increased by 16% (P < 0.05) on coffee consumption, and returned to the original concentration after the washout period. The increase in plasma homocysteine concentration (13% after 1 week of coffee intake) was not significant. No differences in glutathione or homocysteine concentration were observed in the control group. No variation of plasma hydroperoxide concentration was detectable.Conclusions : A coffee intake regimen, representing the average consumption of coffee drinkers in Italy, increased the plasma concentration of glutathione, but no significant increase in the plasma homocysteine concentration was detected.
Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora
Authors: Kuisma J. , Mentula S. , Jarvinen H. , Kahri A. , Saxelin M. , Farkkila M. 
Published: March 2003

SummaryBackground : Preliminary trials of probiotics in preventing recurrent chronic pouchitis have been encouraging.Aim : To investigate the efficacy of Lactobacillus GG supplementation as primary therapy for ileal pouch inflammation, and its effect on the microbial flora.Methods : Twenty patients, with a previous history of pouchitis and endoscopic inflammation, were recruited for a prospective, randomized, double‐blind, placebo‐controlled trial of Lactobacillus GG supplementation (10 LGG, 10 placebo) in two gelatine capsules [(0.5–1) × 1010 colony‐forming units/capsule] b.d. for 3 months. Quantitative bacterial culture of fresh faecal samples and biopsies taken from the pouch and afferent limb was performed before and after supplementation.Results : Lactobacillus GG supplementation changed the pouch intestinal flora by increasing the ratio of total faecal lactobacilli to total faecal anaerobes (P = 0.03) and enhancing the frequency of lactobacilli‐positive cultures in the pouch and afferent limb mucosal biopsy samples. However, only 40% of patients were colonized with Lactobacillus GG. No differences were observed between the groups with regard to the mean pouchitis disease activity index or the total anaerobes or aerobes of faecal or tissue biopsy samples.Conclusions : A single‐strain probiotic bacterium supplement of Lactobacillus GG changed the pouch intestinal bacterial flora, but was ineffective as primary therapy for a clinical or endoscopic response. More clinical trials are needed to evaluate the right placement and dosage of probiotics within a treatment regimen for pouchitis.
Esomeprazole — enhanced bio‐availability, specificity for the proton pump and inhibition of acid secretion
Authors: Lindberg P. , Keeling D. , Fryklund J. , Andersson T. , Lundborg P. , Carlsson E. 
Published: March 2003

SummaryEsomeprazole, the S‐isomer of omeprazole, is the first proton pump inhibitor available for clinical use as a single isomer. It demonstrates pharmacological and clinical benefits beyond those seen with the racemic omeprazole.Esomeprazole has higher and more consistent bio‐availability than omeprazole, which results in a greater area under the plasma concentration–time curve. It is the area under the plasma concentration–time curve of omeprazole and esomeprazole that determines how much of each reaches the parietal cell, and thus the control of gastric acid secretion that is achieved. Esomeprazole, like other proton pump inhibitors, has a high specificity for the acidic environment of the parietal cell, where it is accumulated, activated and covalently inhibits the proton pump. Proton pumps elsewhere in the body do not achieve the level of acidity needed for accumulation and activation.Esomeprazole, 40 mg once daily, provides more effective control of gastric acid secretion than omeprazole, 20 or 40 mg once daily, and all other proton pump inhibitors given at their standard doses. This translates into greater clinical effect compared with omeprazole, 20 mg once daily, and lansoprazole, 30 mg once daily, in the management of reflux disease. Esomeprazole therapy is well tolerated, with a low adverse events profile, similar to that seen with omeprazole.
Costing anaesthetic practice
Authors: Kendell J. , Wildsmith J. A. W. , Gray I. G. 
Published: March 2003

A computerised database of operating theatre activity was used to estimate the costs of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Data retrieved for each procedure included the anaesthetic technique and drugs used, and the duration of anaesthesia, surgery and recovery. The costs of anaesthetic drugs and disposables, salary costs of the anaesthetic personnel and maintenance costs for anaesthetic equipment were considered. Drugs and disposables accounted for ≈ 25% of the total cost of an anaesthetic. Anaesthetic times were 5 min longer for regional anaesthesia, but recovery times were 10 min shorter following regional anaesthesia for varicose vein surgery. Staff costs were dependent on the length of time each staff member spent with the patient. Although the number of cases was small, provision of a field block and sedation for inguinal hernia repair was considerably cheaper than other anaesthetic techniques.
Does sevoflurane inhibit serum cholinesterase in children?
Authors: Lejus C. , Delaroche O. , Le Roux C. , Legendre E. , Rivault O. , Floch H. , Renaudin M. , Pinaud M. 
Published: March 2003

Serum cholinesterase activity was measured at induction, and following anaesthesia in 41 children aged between 4 and 30 months. The median exposure to sevoflurane was 273%.min. The results did not demonstrate any significant difference in cholinesterase activity, when expressed by gram of serum proteins following inhalation anaesthesia using sevoflurane or intravenous anaesthesia using propofol. The values (SD) obtained were 175 (42) UI.g−1 before anaesthesia and 177 (43) UI.g−1 following anaesthesia. The only change in cholinesterase activity detected was related to heamodilution. We conclude that plasma fluoride concentration following sevoflurane administration [13.8 (4.2) µm.l−1] is too low to exert an inhibiting effect on in vivo cholinesterase activity and that the previously reported decrease in mivacurium requirements during sevoflurane anaesthesia is unlikely to be due to inhibition by fluoride ions.
A model of relief forming by tectonic uplift and valley incision in orogenesis
Authors: Sugai  , Ohmori  
Published: March 2003

A model for the change in shape of interfluves by concurrent tectonics and denudation was developed based on the morphometric attributes of landforms. The tributaries flowing down valley side slopes and dissecting low‐relief surfaces on the interfluves are one of the most important elements for relief‐forming processes. They were named as β‐tributaries. The valleyhead altitude (H ), the junction altitude (L) and the valley length (l ) of the β‐tributary were measured. The altitudinal difference (h=H−L), which indicates the local relief, and the average slope of tributary (tan θ=h/L) were calculated. The regression analyses among H, L, l, h and tan θ indicate that the valley length, relief and slope increase with an increase in valleyhead altitude.Based on the functional relations above, the shape of interfluve is a function of uplift, altitude and erosion. This model is used to illustrate the change in cross‐section of interfluves during a period of sustained rock uplift.Successive changes in shape of interfluve can be divided into two substages: (1) the early substage, characterized by trapezoidal cross‐sections with the original low‐relief surfaces and residual, shallow stream networks on the ridges; and (2) the later substage, characterized by a triangular cross‐section, with the original low‐relief surfaces removed and with the interfluves lowered by headward erosion of β‐tributaries. In central Japan, the transitional relief from the trapezoidal to the triangular cross‐section appears when the ridges of interfluves attain elevations about 1600–2000 m above sea level.
Drainage on evolving fold‐thrust belts: a study of transverse canyons in the Apennines
Authors: Alvarez  
Published: March 2003

Anticlinal ridges of the actively deforming Umbria–Marche Apennines fold‐thrust belt are transected by deep gorges, accommodating a drainage pattern which almost completely ignores the presence of pronounced anticlinal mountains. Because the region was below sea level until the folds began to form, simple antecedence cannot explain these transverse canyons. In addition, the fold belt is too young for there to have been a flat‐lying cover from which the rivers could have been superposed.In 1978, Mazzanti & Trevisan proposed an explanation for these gorges which deserves wider recognition. They suggested that the Apennine fold ridges emerged from the sea in sequence, with the erosional debris from each ridge piling up against the next incipient ridge to emerge, gradually extending the coastal plain seaward. The new coastal plain adjacent to each incipient anticline provided a flat surface on which a newly elongated river could cross the fold, positioning it to cut a gorge as the fold grew. Their mechanism is thus a combination of antecedence and superposition in which folds, overlying sedimentary cover and downstream elongations of the rivers all form at the same time.A study of Apennine drainage, using the sequence of older‐to‐younger transected Apennine folds as a proxy for the historical evolution of drainage cutting through a single fold, shows that transverse drainage forms when sedimentation dominates at the advancing coastline. Longitudinal drainage forms when uplift dominates, the folds first emerge as offshore islands and the Mazzanti–Trevisan mechanism is suppressed.Complicating factors include several departures from steady‐state growth of the fold‐thrust belt, a possible case of precursory submarine drainage, early emergence of anticlinal culminations and the location of several transverse canyons at the structurally highest point along anticlinal axes.
Supersequences, superbasins, supercontinents – evidence from the Neoproterozoic–Early Palaeozoic basins of central Australia
Authors: Lindsay John F. 
Published: March 2003

ABSTRACTNeoproterozoic sedimentary basins cover a large area of central Australia. They rest upon rigid continental crust that varies from c. 40–50 km in thickness. Whilst the crust was in part formed during the Archaean and early Palaeoproterozoic, its final assembly occurred at approximately 1.1 Ga as the Neoproterozoic supercontinent, Rodinia, came into being. The assembly process left an indelible imprint on the region producing a strong crustal fabric in the form of a series of north dipping thrusts that pervade much of the thick craton and extend almost to the Moho. Following a period of stability (1.1–0.8 Ga), a large area of central Australia, in excess of 2.5 × 106 km2, began to subside in synchroneity. This major event was due to mantle instability resulting from the insulating effect of Rodinia. Initially, beginning c. 900 Ma, a rising superplume uplifted much of central Australia leading to peneplanation of the uplifted region and the generation of large volumes of sand‐sized clastic materials. Ultimately, the decline of the superplume led to thermal recovery and the development of a sag basin (beginning at c. 800 Ma), which in turn resulted in the redistribution of the clastic sediments and the development of a vast sand sheet at the base of the Neoproterozoic succession.The superbasin generated by the thermal recovery was short lived (c. 20 M.y.) but, in conjunction with the crustal fabric developed during supercontinent assembly, it set the stage for further long‐term basin development that extended for half a billion years well into the Late Palaeozoic. Following the sag phase at least five major tectonic episodes influenced the central Australian region. Compressional tectonics reactivated earlier thrust faults that had remained dormant within the crust, disrupting the superbasin, causing uplift of basement blocks and breaking the superbasin into the four basins now identified within the central Australian Neoproterozoic succession (Officer, Amadeus, Ngalia and Georgina Basin). These subsequent tectonic events produced the distinctive foreland architecture associated with the basins and were perhaps the trigger for the Neoproterozoic ice ages. The reactivated basins became asymmetric with major thrust faults along one margin paralleled by deep narrow troughs that formed the main depocentres for the remaining life of the basins. The final major tectonic event to influence the central Australian basins, the Alice Springs Orogeny, effectively terminated sedimentation in the region in the Late Palaeozoic (c. 290 Ma). Of the six tectonic episodes recorded in the basinal succession only one provides evidence of extension, suggesting the breakup of east Gondwana at the end of the Rodinian supercontinent cycle may have occurred at close to the time of the Precambrian–Cambrian boundary. The central Australian basins are thus the products of events surrounding the assembly and dispersal of Rodinia.