CONTEXT: The role of serologic testing to confirm cure of Helicobacter pylori infection after antimicrobial therapy is not completely defined. OBJECTIVE: To determine the utility of serologic testing in confirming cure of H pylori infection more than 1 year after therapy. DESIGN: A prospective, before-after interventional trial. SETTING: An outpatient clinical research laboratory in an academic, urban Veterans Affairs medical center. PARTICIPANTS: Twenty-three otherwise healthy men and women with active H pylori infection demonstrated by gastric biopsy and with positive H pylori serologic findings. INTERVENTION: A 14-day course of bismuth, tetracycline, and metronidazole. MAIN OUTCOME MEASURES: Determination of IgG serum antibodies to H pylori at baseline, 1 month, 3 months, and approximately 18 months after completion of therapy compared with serial gastric mucosal biopsy specimens with stains for H pylori and for histologic examination as the criterion standard. RESULTS: Fifteen (65%) of 23 subjects were cured of their H pylori infection as assessed by gastric biopsy, with elimination of gastritis; median antibody levels declined from 92.5 U/mL at baseline to undetectable levels at 18 months. The other 8 subjects (35%) were not cured and had persistent gastritis at 18 months; median antibody levels declined from 130.6 U/mL at baseline to 89.7 U/mL at 18 months. Sensitivity and specificity of seroconversion (from a positive to negative test result) in detecting cure of H pylori infection were 60% and 100%, respectively. CONCLUSION: Undetectable antibody levels beyond the first year of therapy accurately confirm cure of H pylori infection in initially seropositive healthy subjects, with reasonable sensitivity.

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PubMedDate not supplied

Pulmonary reaction to intravenously injected polymer beads.

The purpose of this study was to characterize the foreign body reaction in the mouse lung following embolization of intravenously injected divinylbenzene copolymer beads. In contrast to usual surgical implantation, this model dissociates the local foreign body reaction to the beads (in the lung) from inflammation and repair of tissue injury associated with implantation (peripheral site of injection). Quantitative determinations of pulmonary granuloma area using light microscopic morphometric measurements on tissue sections confirmed that the intensity of pulmonary inflammatory reaction increased rapidly to a maximum at 48 h following injection, with a volume exceeding 10 times that of the bead; at this time, the cellular exudate was 90% polymorphonuclear leukocytes. Thereafter, the inflammatory reaction decreased in intensity, and individual lesions became progressively richer in mononuclear cells (60% at 4 days and greater thereafter). Determination of intra- and interobserver variability indicated that maximal data precision was attained by measurement of the cross-sectional areas of as few as 10 granulomas in each of five animals for each set of specific experimental conditions. Collagen was undetectable in granulomas at 7 weeks and 6 months, suggesting that the usual fibrous capsule forming in response to surgically implanted biomaterials is largely caused by repair of surgical trauma. The volume of inflammatory exudate at 48 h was reduced 68-86% by the nonsteroidal antiinflammatory agents indomethacin, aspirin, and ibuprofen and the antiinflammatory steroid methylprednisolone. Thus, the pulmonary bead granuloma model is a quantitative, reliable, and economical approach to investigating some aspects of biomaterial/time interactions in the absence of super-imposed surgical trauma.

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PubMedDate not supplied

Intake of nutrients related to cardiovascular disease risk among three groups of American Indians: the Strong Heart Dietary Study.

BACKGROUND: Although diet is implicated in the elevated rate of cardiovascular disease among some American Indian tribes, the dietary intakes of these individuals have not been described. The Strong Heart Dietary Study compared diets of 10 tribes in Arizona, Oklahoma, and the Dakotas to examine the possible contribution of diet to cardiovascular and other chronic diseases. METHODS: During 1988-1991, 892 people responded to a 24 hr diet recall questionnaire. Nutrient intake by study area, sex, and age group were compared by analysis of variance, and intakes were compared with nutrient intakes reported by participants in Phase 1 of the Third National Health and Nutrition Examination Survey and with dietary recommendations of the National Research Council, the American Heart Association, and the Healthy People 2000 objectives. RESULTS: The intake of energy and nutrients varied significantly by sex and age. Men consumed more energy, macronutrients, and sodium than did women (P < or = 0.001). Women's diets were denser in carbohydrate, beta-carotene, vitamin C, and vitamin E than were men's diets (P < or = 0.001). Younger participants consumed more energy, macronutrients, vitamin E, and sodium than did older participants (P < or = 0.001). Older participants had diets denser in protein and beta-carotene than did younger participants (P < or = 0.001). Energy intake did not differ significantly by study area, but men in Arizona consumed more energy from carbohydrate and less energy from total fat than did men elsewhere (P < or = 0.01). Men and women in Arizona consumed more cholesterol and fiber than did other participants (P < or = 0.01) and less of the antioxidant vitamins (P < or = 0.01). Participants in the Strong Heart Diet Study reported diets higher in fats and cholesterol than did participants in Phase 1 of the Third National Health and Nutrition Examination Survey. Few Strong Heart participants achieved dietary recommendations for the reduction of risk of chronic disease. CONCLUSIONS: Area differences in nutrient intake were observed, but most participants consumed diets associated with increased risk of heart disease and other chronic diseases. Women and older participants in general reported healthier nutrient intakes. Dietary intervention programs should educate American Indians about dietary modifications to reduce the risk of cardiovascular and other nutrition-related disorders.

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