In this study, we investigate simple breath test for detection of Helicobacter pylori (HP) infection using 13C-urea. Thirty-nine patients (30 were HP positive, 9 were HP negative) were given three different doses (50, 100 and 150mg) of 13C-urea at fasting, and keep siting after mouth washing with water. Breath samples were taken before and 10, 20, 30, 45, and 60 minutes after urea administration. More than 100mg of 13C-urea was necessary for correct diagnosis of HP infection, because 2 HP positive cases were not detected by 50mg 13C-urea administration. In cases with patchy distribution of HP in the stomach, it may be necessary to change the posture to distribute urea within the whole stomach. In most of HP positive cases, peak δ13CO2 were obtained within 30 minutes, but one HP negative case showed high δ13CO2 at 10 minutes, which was probably caused by urease activity in the mouth. So it is appropriate to take breath sample at 20 minutes after urea administration. In this study, cut-off value for a positive test can be setted between 4 to 7 δ‰, it is necessary to investigate much more cases to set exact cut-off value.
The contribution of the endogenous nitric oxide (NO) to the distal colonic motility was investigated by inhibiting NO production using NO synthase inhibitor, NG-monomethyl-L-arginine (L-NMMA). The experiment was carried out in the anaesthetized rat, which was vagotomized and pretreated with guanethidine, phentolamine and propranolol. The colonic motility was evaluated by changes in the increase in intraluminal pressure of the distal colon. L-NMMA infusion (100mg/kg iv) in the presence of atropine (1 mg/kg iv) resulted in a significant increase in arterial blood pressure and intraluminal pressure. The following L-arginine infusion (100mg/kg iv) restored blood pressure and intraluminal pressure to the control level. In contrast, L-NMMA infusion in the absence of atropine resulted in no change in intraluminal pressure with a significant increase in arterial blood pressure. These results indicate that there are NO-dependent and nondependent mechanisms to regulate the distal colonic motility.
To clarify the relationship of bacterial translocation (BT) to remnant liver injury after subtotal (90%) hepatectomy, we compared orally polymyxin B treated rats (PL-B (+)), of which gram-negative rods (GNR) in digestive tract decreased, with control rats (PL-B (-)). The increase in intestinal permeability assessed by lactulose/mannitol ratio in urine, the increase in GNR positive in tissue culture including mesenteric lymphnode, liver, spleen, portal blood, and kidney, and the elevation of serum endotoxin levels showed BT after subtotal hepatectomy in PL-B (-) group. Liver injury was also observed by increased serum GPT levels and massive coagulative necrosis of hepatocytes with bleeding in the remnant liver. In PL-B (+) group rats, BT and liver injury decreased and hepatocyte DNA synthesis increased, while intestinal permeability was the same as PL-B (-) group. It is suggested that BT is the cause of remnant liver injury after subtotal hepatectomy, and oral PL-B treatment is effective in preventing liver injury.
Percutaneous transhepatic cholecyst puncture (PTCCP) is a unique treatment for acute cholecystitis by using of 21 gauge PTC needle with ultrasoundimage control. The procedure is as follows. A percutaneous transhepatic puncture of the gallbladder is made with ultrasonic guidance. After suction removal of the contents of the gallbladder, saline with antibiotics is injected. Finally PTC needle is removed after removal of the injected saline. We carried out PTCCP in 35 patients with acute cholecystitis, and compared its clinical effect with those of PTCCD (46 cases) or conservative treatment of antibiotics administration (38 cases). The treatment of PTCCP removed the clinical symptoms of acute cholecystitis rapidly compared with the conservative treatment and it made the hospitalization shorter compared with the treatment of PTCCD. PTCCP was also performed without any severe complications for patients with underlying diseases. The curative rate of PTCCP was the same as those of other former treatments. It was concluded that PTCCP is a safe, convenient, and useful treatment of acute cholecystitis.