Use of the 14C Breath Test in the Treatment of Helicobacter pylori

Fifty-two patients with gastric disorders referred to the same physician over the course of one year were endoscoped, biopsied and given a 14C breath test to identify Helicobacter pylori. Sensitivity, specificity and accuracy of the 14C breath test were found to be 83%, 89% and 87%, respectively, when taking biopsy results as the `gold standard'. These figures rose to 85%, 93% and 89%, respectively, when the first five cases were not included, representing a ‘learning curve’ associated with the development of cut-off levels for the breath test. In five cases, persons were biopsied and given a breath test at least one month later, making 10 comparisons possible. Biopsy and breath test corresponded in nine of 10 comparisons (90%). In two of four false negatives (14C breath test negative but biopsy positive) only scant numbers of helicobacter organisms were found. In one of three false positives (14C breath test positive but biopsy negative) acute inflammation of the duodenal biopsied material was detected. Also, double eradication therapy (omeprazole 20 mg bid and amoxicillin trihydrate 1000 mg bid), administered in all three false positive cases, was followed by 14C breath testing six weeks later, which indicated normal scores or absence of the organism

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand