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Aims: Standard triple therapy remains the recommended first line treatment for Helicobacter pylori in New Zealand. The real eradication rate achieved in busy hospital clinics may be different from data obtained from clinical trials outside of New Zealand., Methods: One hundred and thirty patients with proven H pylori infection (by at least two tests) were treated with low dose triple therapy (DeNol 1 qid, tetracycline 250 mg qid and metronidazole 200 mg qid for 2 weeks; dosing with meals and at night); 83 were given a standard prescription for triple therapy (dispensed in bottles) and 47 were given a medication pack with times of dosing clearly marked. Eradication was proven by a negative 13C urea breath test at least 4 weeks after finishing treatment., Results: Follow up urea breath test was obtained in 120 patients (92%). The eradication rate for separate bottles was 79% and for the medication pack 76%. Compliance was estimated to be greater than 90% in 92% of patients who attended for followup. H pylori culture and sensitivity results were available for 41 patients. Overall rate of metronidazole resistance was 32%. The eradication rate for metronidazole sensitive strains was 89% and for resistant strains 46%. Mild side effects were reported in 10% and moderate side effects in 10%. No patient stopped treatment because of side effects. There was no effect of age, ethnicity, smoking, alcohol intake, pretreatment with H2-antagonists or endoscopic diagnoses on eradication rates., Conclusion: The low dose triple therapy has an acceptable real eradication rate. The most important determinant of success was metronidazole resistance. The eradication rate was not improved by using medication packs.

Aim: Dyspepsia is a common symptom and some selection process for endoscopy is required. This study seeks to determine if noninvasive tests for Helicobacter pylori could be useful as a screening test to help select patients for endoscopy., Methods: Consecutive patients attending for upper gastrointestinal endoscopy were interviewed prior to endoscopy and the endoscopic diagnoses was recorded. The presence of Helicobacter pylori infection was assessed by serology. Some patients also had a 13C urea breath test or rapid urease test (CLO test)., Results: 436 consecutive patients were evaluated. The endoscopy findings were normal in 44%, 29% had reflux oesophagitis, 18% had duodenal ulcer, duodenitis or gastric ulcer and 9% had other diagnoses. 54.8% of patients were positive for Helicobacter serology. Using either the CLO test or 13C urea breath test as the confirmatory test for the diagnosis of Helicobacter pylori, the sensitivity of the serology test was 96% and 91% respectively and the specificity was 66.6 and 82%. Patients with negative serology and no history of recent NSAID or aspirin use comprised 34% of the total with dyspepsia or reflux symptoms. There were no gastric or duodenal ulcers in this group., Conclusion: The serology test may have some potential or the initial evaluation of dyspepsia. These tests need to be prospectively evaluated in general practice.

Thirty-six patients with healed duodenal ulcers, 27 infected with Helicobacter pylori and nine uninfected, were followed for up to 12 months to determine the rate of ulcer relapse. Eight patients withdrew over the follow up period. At one year, 15 of 20 (75%) infected patients and one of eight (13%) uninfected patients had relapsed, p less than 0.05. Eradication of H pylori favourably influences the natural history of duodenal ulcer recurrence. Significant patient morbidity may be prevented by using measures to eradicate H pylori during or after duodenal ulcer healing.

We report a case of rhinocerebral mucormycosis in a patient with poorly controlled diabetes mellitus. The pathology, clinical features, diagnosis and treatment of this disorder are discussed.

Three patients with inferior myocardial infarction complicated by predominant right ventricular (RV) dysfunction are described. Two patients had clinical and haemodynamic evidence of RV infraction associated with pump failure and improved with infusion of plasma expanders and inotropic agents. A third patient presenting with severe RV failure without left ventricular (LV) dysfunction illustrated the haemodynamic similarities between RV infarction and pericardial tamponade.

Experience with 67 liver biopsies performed on outpatients has been retrospectively analysed. One serious complication was encountered but would not have been detected earlier even had the patient been retained in hospital for 48 hours. The results suggest that liver biopsy can be performed on many outpatients with safety.

Antral biopsies were obtained to detect Campylobacter pylori infection in 382 patients referred for gastroscopy. One hundred and seventy four patients (46%) were infected. Infection was strongly associated with histological gastritis (p less than 0.001), but there was no association between histological antral gastritis and the appearance of the gastric antrum during gastroscopy. Because it has been suggested that the lower relapse rate for duodenal ulcer following colloidal bismuth subcitrate (CBS) is due to suppression of C pylori we investigated different formulations and dosing of CBS for their efficacy in clearing C pylori. Seventy four infected patients were prospectively assigned to therapy with pirenzepine (11 patients) or one of four regimens of CBS; one swallow tablet 4 times a day (11 patients); two swallow tablets twice daily (16 patients); two buffered swallow tablets twice daily (14 patients); or two chew tablets twice daily (22 patients). All patients treated with pirenzepine and one CBS swallow tablet 4 times a day were still infected after treatment. Infection was not detected in 16 patients taking twice daily doses of CBS; 8 (50%), 3 (21%) and 5 (23%) patients taking two standard, buffered or chew tabs twice daily respectively. Improvement of histological gastritis was observed only in those patients apparently cleared of C pylori (p less than 0.01) and this was due to a decrease in polymorphonuclear leukocytes. Nine patients apparently cleared of the infection were rebiopsied 44-137 days following treatment and 6 (66%) were found again to be infected. This study suggests that suppression of C pylori may vary with the formulation and dosing of CBS.(ABSTRACT TRUNCATED AT 250 WORDS)

Drainage of the biliary tree and removal of retained common bile duct stones can be achieved by performing a sphincterotomy of the ampulla of Vater using a diathermy sphincterotome directed through a fibre-optic endoscope. The procedure was successfully performed on two patients considered unfit for abdominal surgery. It is a useful method in selected patients to release stones retained in the common bile duct after cholecystectomy.

Idiopathic giant cell myocarditis has not been previously reported from Australasia; a typical case is presented, and the clinical and pathological findings discussed. Possible aetiologies are discussed in the light of positive serology to coxsackie B viruses.