MEDICAL JOURNAL ficient to cause acute pulmonary oedema in a healthy 36-year-old mother having her second elective caesarean section. The same objection applies to the intravenous infusion of plasma expanders.Obstetricians and anaesthetists should be aware of this syndrome. It should be considered in all patients with hypotension lying supine in late pregnancy. Routine inquiry should be made of all patients before caesarean section in regard to fainting attacks, dizziness in the supine position, and difficulty experienced in the antenatal clinics in recording their blood pressure. Constant monitoring of blood pressure is essential, and the obstetrician should not proceed without assurance that it is normal. If supine hypotension is noted before the operation, caesarean section should be performed in the lateral position. Should supine hypotension occur during the operation the patient should be turned on her side and delivered as quickly as possible. Vasopressors and rapid intravenous infusions should not be used until repositioning of the patient has been tried.

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I Tiwari, Z Mazhar, W Uddin, PJH Fletcher, Comparison of Dual and Triple Therapy for the Eradication of Helicobacter Pylori in Duodenal Ulcer Patients. 1997; 17(6): 656-658 Helicobacter pylori (H. pylori) is thought to be responsible for 95% of duodenal ulcers. It is also thought that eradication of this organism will lead to the cure for duodenal ulcers.1 The optimal treatment regime for the eradication of H. pylori has not yet been defined, but the treatment which is effective in developed countries may not be suitable for patients in the developing world. The attempted eradication of H. pylori with antibacterial monotherapy has been not been encouraging. Because of poor compliance and higher side effects from the standard "triple therapy," consisting of bismuth, tetracycline and metronidazole, 2 there is a need to develop a simple, welltolerated regime for the eradication of H. pylori. Recently, a combination therapy with proton pump inhibitors and antibiotics has shown good results for the eradication of this infection. An eradication rate of 98% has been reported with a combination of omeprazole, clarithromycin, and tinidazole for one week.3 Dual therapy with omeprazole and clarithromycin for two weeks gave an eradication rate of 80%. 4 A combination of lansoprazole 30 mg daily for four weeks, and clarithromycin 500 mg three times daily for two weeks, eradicated H. pylori in 54% of patients, 5 while triple therapy with lansoprazole, clarithromycin and metronidazole for one week eradicated the infection in 92% of patients. 6 This combination of therapy has not been tested in patients in the Middle East. We conducted this study to compare the eradication of H. pylori with dual (lansoprazole and clarithromycin) and triple (lansoprazole, clarithromycin and tinidazole) therapy in patients with duodenal ulcer. Patients and MethodsPatients found to have duodenal ulcer on routine gastrointestinal endoscopy were selected for the study. Those with a history of gastrointestinal bleeding, pregnancy or H2 blocker, or antibiotic therapy in the preceding four weeks were excluded. From the eligible patients, three gastric and antral biopsies were taken, one for urease activity (CLO test, Delta West, West Australia), and the other two for histopathology. The tissue for histopathology was fixed in routine formalin fixative and embedded in paraffin wax. Sections were cut at several levels, and stained by hematoxylin and eosin for routine examination, and by the modified Giemsa method for the demonstration of H. pylori. Patients were considered H. pylori-positive if both CLO test and histology were positive. Patients with negative CLO test and histology for H. pylori were excluded from the study. Informed consent was obtained from the H. pylori-positive patients. The study was approved by the local ethics committee.Patients accepted for the study were randomized into two treatment groups by the selection of sealed envelopes. Group A received lansoprazole 30 mg daily for four weeks, and clarithromycin 500 mg twice daily for ...

A case of multiple injuries including blunt rupture of the stomach is reported. It demonstrates that Candida needs to be considered as a possible cause of continued sepsis following a ruptured viscus in the presence of multiple trauma. Surgical drainage is required in this situation, in the same way that abscesses caused by more conventional : organisms require aggressive surgical treatment.

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