The levels of surfactant protein-A (SP-A) and surfactant protein-D (SP-D) in the serum of patients with septic acute respiratory distress syndrome (ARDS) were determined. Patients with sepsis without ARDS were examined as controls. The mean serum SP-A level in the former group was 37.6 +/- 16.2 ng/ml and in the latter group was 31.8 +/- 9.6 ng/ml. The difference between the two groups was not statistically significant. The maximum serum SP-D level was 83.0 +/- 33.9 ng/ml in the control group of patients without ARDS, and 476.3 +/- 391.2 ng/ml in the patients with ARDS. The level in the latter population was significantly higher than that in the former population. No significant correlation was observed between the SP-A and SP-D levels. These results suggest that the serum SP-D levels may serve as a good diagnostic indicator of ARDS in patients with sepsis.

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Improvement of gastric atrophy after Helicobacter pylori eradication therapy.

BACKGROUND: It remains controversial whether gastric atrophy is reversible after Helicobacter pylori eradication therapy. AIM: To clarify whether gastric atrophy improves after H. pylori eradication therapy using a histologic approach. METHODS: Subjects were 87 H. pylori infection-cured patients (treatment group) and 29 continuously H. pylori-infected patients (control group). The subjects in the treatment and control groups were followed for 10-49 months (mean, 22 months) and 11-50 months (mean, 22 months), respectively. Biopsy specimens were obtained from the greater curvature of the antrum and corpus at the beginning and end of the observation period; histologic analyses of these specimens were performed for detection of activity, inflammation, atrophy, and intestinal metaplasia. Results were scored without any clinical information according to the Sydney system. RESULTS: In the treatment group, the histologic score for atrophy was improved in the corpus but not in the antrum. Intestinal metaplasia was not improved in either the antrum or the corpus. There were no significant differences during the follow-up in gastric atrophy and intestinal metaplasia in the control group. CONCLUSION: Gastric atrophy was improved in the corpus approximately 2 years after H. pylori eradication therapy.

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Increased esophageal sensitivity to acid and saline in patients with nonerosive gastro-esophageal reflux disease.

GOALS: To investigate the features of nonerosive reflux disease (NERD). BACKGROUND: NERD is not considered as a milder form of erosive gastro-esophageal reflux disease (eGERD). Although the prevalence of NERD was reported to be high in our country, there have been very few studies about NERD. STUDY: We performed upper gastrointestinal endoscopy to confirm the diagnosis of GERD. The modified acid perfusion test and saline perfusion test were performed in 7 control subjects, 14 NERD, and 11 eGERD patients. The stimulus-response function to acid and saline was quantified by the duration of typical symptom perception (minutes), total sensory intensity rating (0 to 10), and the perfusion sensory score (SS), which was defined as the product of minutes and the sensory intensity rating. RESULTS: The mean value of SS by saline was 0 in control subjects, 12.0 in NERD patients, and 1.5 in eGERD patients (P<0.01 control vs. NERD, P<0.01 NERD vs. eGERD). The mean SS with acid was 0.9 in control subjects, 52.5 in NERD patients, and 23.0 in eGERD patients (P<0.01 control vs. NERD, control vs. eGERD, P<0.05 NERD vs. eGERD). A statistically significant association was shown between the acid and saline perfusion SSs with a correlation coefficient value of r=0.57 in the NERD group (P<0.05). CONCLUSIONS: Both eGERD and NERD, but especially NERD, exhibited esophageal hypersensitivity not only to acid but also saline perfusion, suggesting that hyperalgesia to acid and other factors (eg, psychologic and/or autonomic nerve disturbance) may play some roles in symptom generation in NERD.

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PubMedDate not supplied

Failure in presumption of residual disease by quantification of FDG uptake in esophageal squamous cell carcinoma immediately after radiotherapy.

To assess whether differentiation is possible between residual disease and complete response, 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography was performed in 17 cases of primary squamous cell carcinoma of the thoracic esophagus before (five control cases) or immediately after full-dose irradiation (12 treated cases). The FDG counts in the esophageal tumors were corrected by the dose of injected isotope and the weight of the patient, to produce a standardized uptake value (SUV). Endoscopy for post-treatment evaluation showed almost complete clearance of the tumor in seven treated cases (good-responders) and apparent residual tumor in the other five cases (poor-responders). There was a significant difference in the average median SUV between the controls and the treated (8.1 +/- 1.6 vs. 3.3 +/- 1.1), and between the poor-responders and good-responders (4.1 +/- 0.8 vs. 2.7 +/- 0.9). Three of the good-responders showed locoregional recurrence after four, six, and 18 months. Among the good-responders, the SUV of the cases of local recurrence was not inevitably higher than that of the others. The rate of FDG uptake in irradiated esophageal cancer approximately represents tumor response to radiotherapy, but it seemed impossible to differentiate residual disease from complete response.

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