The interaction between the bacteria and the host is a key factor determining the clinical consequences of H. pylori infection. The immune system plays an important role in either promoting or preventing the disease. The mucosal production of TNF-alpha, IL-6, IL-8 and IL-10 and the CagA status were investigated in H. pylori-positive patients with duodenal ulcer (DU). The concentrations of these cytokines in gastric antral mucosal specimens from patients infected with H. pylori (n = 40) were determined by ELISA and compared with data on mucosal specimens from H. pylori-negative patients (n = 12). The local TNF-alpha, IL-6 and IL-8 concentrations in the antral biopsy samples were significantly higher (p < 0.001) in the patients infected with H. pylori than in the samples from the H. pylori-negative subjects. CagA positivity was demonstrated in 39 (97.5%) of the 40 patients with DU, and in 41 (70.7%) of H. pylori-positive (58 of 100) healthy blood donors. In complementary studies focusing on extragastric disease, it was found that 57% of patients with ischaemic heart disease were seropositive as concerns H. pylori, and 91% of them had antibodies against human heat shock protein 60, too. This study suggests that, besides the bacterial virulence factor, the host response of an increased mucosal production of inflammatory cytokines can be relevant to the gastric pathophysiology in H. pylori-induced DU. At the same time, in ischaemic heart diseases the role of autoimmune processes induced by H. pylori cannot be excluded.
Objective-To establish the time of onset of dilated cardiomyopathy (DCM) by review of annual chest x rays, which are obligatory in Hungary. Design-A retrospective survey of chest x rays of a cohort of confirmed cases of DCM, to assess time of onset of cardiomegaly. Clinical course was compared by follow up over a mean of six years from the time of diagnosis. Subjects-240 patients with DCM (31 familial, 209 non-familial). Diagnosis was made by echocardiography in all cases and confirmed by coronary angiography and heart biopsy in some cases. Main results-At diagnosis, the mean age of the patients was 31-8 years in the familial group and 39-6 years in the nonfamilial group (P < 0.05). The time between the onset of cardiomegaly (cardiothoracic ratio >0.45) and clinical diagnosis was 8-0 and 1041 years respectively (P < 0.05). The six year survival was 6% in the familial group and 23% in the non-familial group (P < 0.05).Conclusions-The familial form of DCM is the more malignant form: it occurs at an earlier age and progresses more rapidly than non-familial DCM. (Br Heart J 1995;74:171-173) Recent data'-3 show that familial dilated cardiomyopathy (DCM) is a not such a rare disease as was earlier believed. However, our knowledge about the age of onset of this form of cardiomegaly is limited as we only know the time of the onset of the clinical symptoms and signs of the disease. The clinical course of DCM is apparent only after the diagnosis has been made, while the real start of the disease before the onset of symptoms remains hidden. In Hungary, annual chest x ray screening is obligatory, and we are therefore in a position to acquire information retrospectively on the earlier "latent" period of the disease. The changes in heart size of DCM patients can be analysed by means of the cardiothoracic ratio, and the extent of cardiomegaly can be characterised by the increase in the ratio. For this study, we selected patients on whom previous annual cardiothoracic ratio data were available. These patients were examined and followed very thoroughly, allowing us not only to determine the onset of cardiomegaly, but also to follow up the progression of the disease.
MethodsA comparison was made of 31 patients with familial DCM and 209 patients with sporadic DCM, for all of whom previous annual chest x ray pictures were available. The familial DCM group consisted of 12 females and 19 males, while the non-familial group consisted of 68 females and 141 males. The cardiothoracic ratio was measured by the method of Groedel and Danzer, and values of >0 45 were taken as pathological.6 We considered the disease to be of the familial form if we found at least two patients with frankly abnormal left ventricular function in the same family, and if at least two generations were involved. We recorded a detailed familial case history and examined all family members if possible. When relatives of DCM patients were not available for examination or were not alive, we asked for earlier medical reports, findings, and documentations. Th...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.