Aboralis pótgyomor prospektív randomizált összehasonlítása hagyományos orális pótgyomorral totális gastrectomia után = Prospective randomised comparison of aboral pouch with conventional oral pouch after total gastrectomy.

Prospektív randomizált vizsgálat keretében hasonlítottunk össze totális gastrectomia után két rekonstrukció típust, az aborális és az orális pótgyomrot a duodenális passzázs megtartásával. 28 beteg lépett be a tanulmányba. A betegeknél antropometriai és laborparaméterek mérése, izotópos passzázs vizsgálat, zsír és szénhidrát felszívódási vizsgálatok valamint életminőségi kérdőív kitöltése történt. Nem találtunk szignifikáns különbséget az elsődleges kimeneteli paraméterekben, és minimálisat a másodlagosakban, ezért a konklúzió, hogy a pótgyomor helye nem befolyásolja a kimenetelt. Befejeztük a korábbi aborális pouch versus Roux-Y tanulmány hosszú távú utánvizsgálatát. A fentivel azonos mérések történtek, és csak a másodlagos paraméterekben találtunk némi különbséget. A gastrointestinális hormonmérések tesztétel után különböző rekonstrukció típusoknál elvégeztünk. Szignifikáns különbségeket találtunk a cholecystokinin és somatostatin szintekben a duodenális passzázst megőrző rekonstrukciók javára. A Manometriás és Bilitec epés reflux mérések a total gastrectomián átesett betegeken még zajlanak, 14 betegnél végeztünk endoscopiát, manometriát és Bilitec vizsgálatot. | In a prospective randomised trial we compared two types of surgical reconstructions, the aboral and the oral pouch construction with preservation of the duodenal passage after total gastrectomy. 28 patients entered the study. Primarily body weight, body mass index and quality of life, secondarily serum nutritional parameters, scintigraphic small intestinal passage, lipid and carbohydrate absorption were measured. No significant differences were found in the primary outcome measures, while some differences regarding the secondary outcome. In summary the site of the reservoir does not influence the functional outcome of reconstruction after total gastrectomy. Also the long term examinations for the aboral pouch versus Roux-en-Y study was finished. The above follow-up measurements were carried, and we found some difference in secondary outcome measures only. The gastrointestinal hormone measurements following ingestion of a test food at different types of reconstructions was finished. Significant differences were found in cholecystokinin and somatostatin production in favour of reconstructions preserving the duodenal passage. The manometry and Bilitec biliary reflux studies are still going on. Upper endoscopy, esophageal manometry and 24 hour Bilitec examinations were carried out for 14 patients

Chlamydia pneumoniae in atherosclerotic middle cerebral artery

Background and Purpose—Atherosclerotic middle cerebral arteries are frequent sites of thrombosis, leading to stroke. Previous studies have suggested a role for Chlamydia pneumoniae in the pathogenesis of atherosclerosis. However, the presence of this pathogen in atherosclerotic middle cerebral arteries has heretofore not been documented. In the present study, we analyzed atheromatous plaques from middle cerebral arteries for the presence of C pneumoniae. Methods—Atherosclerotic middle cerebral arteries from 15 cadavers who died of natural causes and corresponding nonatherosclerotic arteries from 4 otherwise healthy trauma victims were examined. Assays for C pneumoniae DNA were carried out by nested polymerase chain reaction (nPCR) specific for the C pneumoniae ompA gene. The presence of the bacterium was assessed by transmission electron microscopy. Results—Five of the 15 atherosclerotic arterial samples and none of the control tissues were positive for C pneumoniae by nPCR. Particles similar in morphology and size to C pneumoniae elementary bodies were detected by transmission electron microscopy in 4 of the 5 nPCR-positive atherosclerotic samples. Conclusions—The demonstration of C pneumoniae in atherosclerotic middle cerebral arteries is consistent with the hypothesis that this bacterium is involved in acute and chronic cerebrovascular diseases

Independent and joint effects of antibodies to human heat-shock protein 60 and Chlamydia pneumoniae infection in the development of coronary atherosclerosis

Background—Studies have suggested that the prevalence of antibodies against heat-shock proteins (HSPs), Chlamydia pneumoniae (Cpn), and cytomegalovirus (CMV) is associated with coronary artery disease (CAD), but the independent or joint effects of human (h) HSP60 antibodies and these pathogens in patients have not been fully elucidated. Methods and Results—A total of 405 subjects (276 patients with CAD and 129 control individuals) were tested for serum antibodies to hHSP60, Cpn, and CMV immediate-early-1 (IE1) antigens. Patients were also assessed for serum cholesterol, triglyceride levels, and smoking habit. Significantly elevated levels of antibodies to hHSP60 and Cpn but not to CMV-IE1 antigens were documented in CAD patients. Multiple logistic regression analysis and subanalyses of selected subjects showed that these associations were independent of age, sex, smoking, and serum lipid levels. Antibodies to hHSP60 and Cpn did not correlate quantitatively; however, the relative risk of disease development was substantially increased in subjects with high antibody levels to both hHSP60 and Cpn, reaching an odds ratio of 82.0 (95% CI 10.6 to 625.0). Conclusions—High levels of antibodies to hHSP60 and Cpn are independent risk factors for coronary atherosclerosis, but their simultaneous presence substantially increases the risk for disease development