The partnership agreement between taxpayer and his sons was oral. The local paper announced the dissolution of the Coon and Culbertson partnership and the continuation of the business by respondent and his boys under the name of Culbertson & Sons. A bank account was opened in this name, upon which taxpayer, his four sons and a bookkeeper could check. At the time of formation of the new partnership. Culbertson's oldest son was 24 years old, married, and living on the ranch, of which he had for two years been foreman under the

737

*737Coon and Culbertson partnership. He was a college graduate and received $100 a month plus board and lodging for himself and his wife both before and after formation of Culbertson & Sons and until entering the Army. The second son was 22 years old, was married and finished college in 1940, the first year during which the new partnership operated. He went directly into the Army following graduation and rendered no services to the partnership. The two younger sons, who were 18 and 16 years old respectively in 1940, went to school during the winter and worked on the ranch during the summer.^[2]

Question 1

Is telithromycin as, or more, effective than clarithromycin in the

treatment of Helicobacter pylori? If so, what is the recommended dosage

and how long should treatment be continued?c625

Question 2

Currently favoured regimens for eradication of Helicobacter pylori are

triple therapy with a proton pump inhibitor along with two antibiotics

for 1 week. For example:

Omeprazole 20 mgmetronidazole 400 mg and clarithromycin

500 mg (all twice daily).

Omeprazole 20 mgclarithromycin 500 mg and amoxicillin 1 g (all

twice daily).

Resistance to amoxicillin has not yet been demonstrated.

Previously, regimens such as omeprazole, metronidazole, amoxicillin

and clarithromycin were recommended; are these regimens no longer used?

The reason behind this question is the 'sky-high' cost of clarithromycin in

Pakistan, which is inversely proportional to patient compliance (that is,

low-cost regimens tend to have a higher rate of compliance).

Question 3

What is the difference between the management of a gastric and of a

duodenal ulcer?

Question4

How does omeprazole suppress Helicobacter pylori?

Question5

Does omeprazole cause rebound hyperacidity? Does this also apply to

H2-blockers?

Question6

On (K&C 7e, p. 249), you state that the postsynaptic neurotransmitter that

inhibits the relaxation of lower oesophageal sphincter (LOS) is nitric

oxide (NO). I have understood NO to promote relaxation of LOS by

acting on the non-adrenergic, non-cholinergic (NANC) inhibitory

neurones, which inhibits the action of ch

Question 7

1. Where is the Traub's area situated anatomically?

2. What does it mean if it is dull on percussion?

3. What is the proper way to percuss this area?

Question 8

In general, it is claimed that only water and some salts are absorbed

in the large gut, whereas the small gut is practically free of bacteria

(which are present only in the large gut). In a patient on broad-spectrum

antibiotics, bleeding can occur as a result of vitamin K deficiency. If the

flora synthesizing vitamin K is disturbed, how can vitamin deficiency

occur when the large gut is not supposed to absorb? How can this be due

to a change in bacterial flora?

Question 9

Why does colonic cancer more commonly occur on the left rather than

the right side of the colon?

Question 10

How much more likely are patients with reflux oesophagitis to develop

cancer of the oesophagus than normal people and does aggressive

treatment with H2-blockers or proton pump inhibitors nullify this

increased risk?

Question 11

In Crohn's disease localized to the ileum there are long-term side effects

and pros and cons of drug therapy. Is ileal resection a better option

(if Crohn's disease is localized to the ileum) than long-term medicine

therapy which risks complicating lymphoma of the ileum?