1,721,150 research outputs found
Helicobacter pylori eradication and aspirin: a puzzle yet to be solved
Full text linkWe read with great interest the Article by Chris Hawkey and colleagues1 on the Helicobacter Eradication Aspirin Trial (HEAT). The authors should be commended for performing such a complex trial. Although the trial was conceived to evaluate the role of Helicobacter pylori eradication in older patients (aged ≥60 years) prescribed aspirin, the study was not planned to verify eradication. A breath retest was randomly performed in only 10% of patients, reporting H pylori eradication in 146 (90·7%) of 161 patients receiving active eradication therapy. Such high eradication is usually achieved only with quadruple therapies lasting 10 days or longer, but not with 7-day triple therapies.2, 3 Furthermore, H pylori eradication was unexpectedly observed in 41 (24·0%) of 171 patients in the placebo group. Although exposure to clarithromycin, which occurred in 13 (32%) of the 41 control patients with a negative repeat breath test, might theoretically support these results,4 there is no clear explanation for the remaining cases. These findings suggest that it would have been worthwhile to assess eradication in a new larger random sample in both groups.
During the first 2·5 years of follow-up, prescriptions for aspirin decreased progressively in both study groups, while prescriptions for proton pump inhibitors increased in both groups. Even if analyses were adjusted for time-varying prescribed medications, this trend might have had consequences on the second part of follow-up with regard to the primary outcome, and a type two error cannot be excluded.
HEAT is an important study showing that H pylori eradication confers some benefits in the primary prevention of ulcer bleeding. However, future trials should evaluate H pylori eradication in all enrolled patients, and adopt more rigorous criteria on the use of proton pump inhibitors to better clarify the effect of eradication on aspirin-associated ulcer bleeding
Re: Axelsen SM, Bek KM, Petersen LK. 2007. Urodynamic and ultrasound characteristics of incontinence after radical hysterectomy. Neurourol urodynam
No full text[No abstract available
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Where should bulking agents for female urodynamic stress incontinence be injected?
No full text[No abstract available
Urinary Incontinence After Radical Vulvectomy Treated with Macroplastique Implantation
No full textPostradical vulvectomy urinary incontinence is a common surgery-related complication, especially after subtotal urethrectomy. However, only 1 trial has been reported in the previous literature that described a case of total urinary incontinence treated with an Aldridge sling operation. We present 2 cases of patients affected by postradical vulvectomy, with partial urethral resection and total incontinence successfully treated by transurethral Macroplastique injection. This procedure could be considered as a valid, minimally invasive surgical option to improve the well-being of patients with vulvar cancer affected by postradical vulvectomy urinary incontinence, especially in elderly patients at high operative risk. © 2008 AAGL
A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series
No full textTailoring the parametrectomy in stages IA2-IB1 cervical carcinoma: Is it feasible and safe?
No full textObjective. Several authors have proposed the use of a less aggressive surgery (i.e., modified or type 2 radical hysterectomy) for patients affected by early stages cervical carcinoma. However, little attention has been given to the evaluation of adverse prognostic factors before selecting the surgical approach. The aim of this study is to evaluate the feasibility and safety of tailoring parametrectomy on the basis of specific prognostic factors preoperatively assessed. Methods. Patients with cervical carcinoma FIGO IA2-IB1 entered the study. Eligibility criteria were: age < 75 years, no contraindications for surgery, informed consent, expected cooperation for follow-up. Tumor size was preoperatively assessed by pelvic examination under anesthesia and pelvic MRI. Patients were submitted to systematic lymphadenectomy of superficial obturator, external iliac, and interiliac nodes by laparotomy or laparoscopy. Lymph nodes were sent for frozen section. Node-negative patients were submitted to modified radical hysterectomy (type 2). Patients with nodal metastases underwent classical radical hysterectomy (types 3-4) and systematic pelvic and aortic node dissection up to the inferior mesenteric artery. Survival rates were calculated using the Kaplan-Meier product-limit method. Results. Eighty-three patients were enrolled in the study. Among these, 63 patients were node-negative at frozen section, and therefore submitted to modified radical hysterectomy (Group A); 20 patients were found having nodal metastases intra-operatively, and therefore submitted to classical radical hysterectomy (Group B). Median follow up was 30 months. Five years overall survival was 95% for Group A, and 74% for Group B. Conclusions. Pre-treatment evaluation of adverse prognostic factors in patients affected by cervical cancer FIGO stages IA2-IB1 is feasible and mandatory to determine if a less radical surgery is applicable and safe. © 2004 Elsevier Inc. All rights reserved
Trends in Primary Antibiotic Resistance in H. pylori Strains Isolated in Italy between 2009 and 2019
Full text linkBackground and aims: the increasing prevalence of strains resistant to antimicrobial agents is a critical issue for the management of Helicobacter pylori infection. This study aimed to evaluate, in Italian naïve patients, H. pylori antibiotic resistance trends and their potential predictive factors during the last decade. Methods: consecutive Italian naïve H. pylori positive patients, referred from General Practitioners to our Unit from January 2009 to January 2019 to perform an upper gastrointestinal endoscopy (UGIE), were considered. Each patient underwent 13C-urea breath test (13C-UBT) and UGIE with multiple biopsies to perform rapid urease test (RUT), culture/susceptibility test (vs. clarithromycin, metronidazole, levofloxacin), and histopathological examination. H. pylori status was assessed through CRM (composite reference method: at least two tests positive or only culture positive). Results: between 2009 and 2014, 1763 patients were diagnosed as H. pylori positive, 907 were naïve with antibiogram available. Between 2015 and 2019, 1415 patients were diagnosed as H. pylori positive, antibiotic susceptibility test was available in 739 naïve patients. H. pylori primary antibiotic resistance rates in the first and second five-year period were, respectively, clarithromycin 30.2% (95% CI 27.2–33.3), 37.8% (95% CI 34.2–41.4); metronidazole 33.3% (95% CI 30.2–36.5), 33.6% (95% CI 30.2–37.1); levofloxacin 25.6% (95% CI 22.8– 28.5), 33.8% (95% CI 37.4–47.4), double resistance clarithromycin-metronidazole 18.9% (95% CI 16.4– 21.6), 20.7% (95% CI 17.8–23.8). The increase of the resistance rates to clarithromycin and levofloxacin in naïve patients was statistically significant (p < 0.05). Although eradication rates for sequential therapy in the 10 years considered were 93.4% (95% CI 92–94.6) and 87.5% (95% CI 85.7– 89) at per-protocol (PP) and intention-to-treat (ITT) analysis, respectively, they showed a significant decrease in the second five-year period. Conclusions: this data highlights an increase in primary H. pylori antibiotic resistance and strongly suggests the importance of drug susceptibility testing also in naïve patient
Pylera and sequential therapy for first-line Helicobacter pylori eradication: A culture-based study in real clinical practice
No full textBackground and aims Italian guideline suggests 10-day sequential or bismuth-based quadruple therapies for first-line Helicobacter pylori treatment. Comparison between these regimens is lacking. We assessed the efficacy of these therapies in clinical practice and evaluated the role of primary bacterial resistance toward clarithromycin and metronidazole. Patients and methods Consecutive patients with H. pylori infection were enrolled. Bacterial culture with antibiotics susceptibility testing was attempted in all cases. Patients received either a sequential therapy with esomeprazole 40 mg for 10 days plus amoxicillin 1000 mg for the first 5 days followed by clarithromycin 500 mg and tinidazole 500 mg (all twice daily) for the remaining 5 days, or bismuth-based therapy with esomeprazole 20 mg twice daily and Pylera 3 tablets four times daily for 10 days. H. pylori eradication was assessed by using13C-urea breath test. Results A total of 495 patients were enrolled. Following sequential (250 patients) and quadruple (245 patients) therapies, the eradication rate were 92 and 91%, respectively, at intention-to-treat analysis and 96 and 97%, respectively, at per protocol analysis. Overall, the pattern of bacterial resistance did not significantly affect the cure rate, but the presence of clarithromycin and metronidazole dual resistance tended to reduce the success rate of both sequential (84.8 vs. 90.1%; P =0.4) and quadruple (85 vs. 94.1%; P= 0.06) therapies. Adverse events occurred more frequently with the quadruple than with sequential therapy (56.9 vs. 25.8%; P <0.001). Conclusion In our country, sequential and bismuth-based quadruple therapy achieved similarly high eradication rates as firstline treatments for H. pylori infection in clinical practice
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