Laparoscopic-assisted colonic resection gives significant improvements in return of gastrointestinal function and length of stay, with an increased operative time and no difference in the postoperative complication rate.

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Non-invasive monitoring of breath ammonia and trimethylamine using Selected-ion-flow-tube mass spectroscopy (SIFT-MS) could provide a real-time alternative to current invasive techniques. Breath ammonia and trimethylamine were monitored by SIFT-MS before, during and after haemodialysis in 20 patients. In 15 patients (41 sessions), breath was collected hourly into Tedlar bags and analysed immediately (group A). During multiple dialyses over 8 days, five patients breathed directly into the SIFT-MS analyser every 30 min (group B). Pre- and post-dialysis direct breath concentrations were compared with urea reduction, Kt/V and creatinine concentrations. Dialysis decreased breath ammonia, but a transient increase occurred mid treatment in some patients. Trimethylamine decreased more rapidly than reported previously. Pre-dialysis breath ammonia correlated with pre-dialysis urea in group B (r(2) = 0.71) and with change in urea (group A, r(2) = 0.24; group B, r(2) = 0.74). In group B, ammonia correlated with change in creatinine (r(2) = 0.35), weight (r(2) = 0.52) and Kt/V (r(2) = 0.30). The ammonia reduction ratio correlated with the urea reduction ratio (URR) (r(2) = 0.42) and Kt/V (r(2) = 0.38). Pre-dialysis trimethylamine correlated with Kt/V (r(2) = 0.21), and the trimethylamine reduction ratio with URR (r(2) = 0.49) and Kt/V (r(2) = 0.36). Real-time breath analysis revealed previously unmeasurable differences in clearance kinetics of ammonia and trimethylamine. Breath ammonia is potentially useful in assessment of dialysis efficacy.

Experiments were performed using the standardized murine model of Helicobacter pylori infection to determine the immunogenicity of H. pylori outer membrane vesicles in immune protection. These vesicles, which are naturally shed from the surface of the bacterium, induce a protective response when administered intragastrically to mice in the presence of cholera holotoxin, despite the absence of the urease enzyme and associated Hsp54 chaperonin. Immunoblotting identified a specific serum immunoglobulin G (IgG) response to an 18-kDa outer membrane protein in a significant number of immunized animals. This commonly expressed, immunodominant protein was subsequently identified as lipoprotein 20 (Lpp20). Hybridoma backpacks secreting an IgG1 subclass monoclonal antibody to Lpp20 were generated in H. pylori-infected mice and were found to significantly reduce bacterial numbers, providing evidence that this surface-exposed antigen is a true vaccine candidate and not merely an antigenic marker for successful, protective immunization.Helicobacter pylori, a bacterium which is estimated to infect more than half the world's population, is associated with peptic ulcer disease (4) and the development of gastric cancer (32). Immunization against this bacterium represents a cost-effective strategy to reduce global gastric cancer rates (5) and would also have a major impact on H. pylori-related peptic ulcer disease. H. pylori vaccine candidates identified to date include the urease enzyme (20,40,51,55) and the urease enzyme chaperonin heat shock protein A (21). Mice immunized with purified VacA cytotoxin are also protected from challenge with a Tox ϩ strain of H. pylori (48). A common factor among these three vaccine candidates is their reported association with the outer membrane of H. pylori (1,16,17,27,36,52,57). The potential of catalase as an H. pylori vaccine candidate has also been identified (58). This enzyme, which is found in both the cytosol and the periplasmic space of H. pylori (28), is also thought to be surface exposed (57). More recently, the screening of recombinant H. pylori antigens (30) has identified another five potential H. pylori vaccine candidates. These include Lpp20, a conserved H. pylori lipoprotein that is membrane associated but not surface exposed (38).In our search for candidate H. pylori vaccine antigens, we have focused on the outer membrane of the bacterium. Like many other gram-negative bacteria (reviewed in reference 25), H. pylori and Helicobacter felis shed part of their outer membrane as vesicles when grown under certain conditions (34). These outer membrane vesicles (OMV) are thought to be formed when the outer membrane of the bacterium expands faster than the underlying peptidoglycan layer, resulting in portions of the membrane blebbing off the surface of growing cells (44). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis reveals that the protein and lipopolysaccharide content of these OMV closely resembles that of a Sarkosyl-insoluble outer membrane preparati...