Upper gastrointestinal bleeding as the first manifestation of wegener's granulomatosis

Wegener's granulomatosis is an uncommon inflammatory disease that manifests as vasculitis, granulomatosis, and necrosis. It usually involves the upper and lower respiratory tracts and kidneys. Although it may essentially involve any organ, gastrointestinal [GI] involvement is notably uncommon. A 20-year-old male patient presented with epigastric pain, vomiting, hematemesis, and melena. On physical examination, he was pale. There was no abdominal tenderness or organomegaly. Upper GI endoscopy revealed dark blue-colored infiltrative lesions in prepyloric area. Evaluation of the biopsy sample showed mononuclear cell infiltration in the submucosal area, hyperplastic polyp, and chronic gastritis. High dose proton pump inhibitor and adjunctive supportive measures were given but no change in the follow-up endoscopy was detected. During hospital course, he developed intermittent fever and serum creatinine elevation. 12 days after admission, he developed dyspnea, tachypnea, and painful swelling of metacarpophalangeal joints, and maculopapular rash in extensor surface of the right forearm. Chest radiography showed pulmonary infiltration. Serum c-ANCA titer was strongly positive and skin biopsy revealed leukocytoclastic vasculitis. The patient received methylprednisolone pulse, which resulted in complete recovery of symptoms and gastric lesion. The present case indicates that GI bleeding may be the first manifestation of Wegener's granulomatosis. Moreover, it should be emphasized that gastric biopsy is not characteristic or diagnostic in such patients

[Effects of aerobic training on some inflammatory markers in patients with rheumatoid arthritis]

Rheumatoid arthritis [RA] is more prevalent in women than men and its incidence is in all age group. Patient with RA significantly experience more disability and co-morbidities including cardiovascular diseases in compared with people without RA and this is due to reduced physical activities in the patients. The effect of aerobic training on patients with RA is still unclear. Thus, the aim of this study was to investigate the effects of 8 weeks aerobic training in patients with RA. Twenty three women [mean age 51.96 +/- 7.73 yr and mean weight 72.37 +/- 10 kg] with a diagnosis of RA for more than three years and without any known cardiovascular and brain symptoms were voluntarily enrolled in the study. The patients were divided into aerobic training [n=11] and control groups [n=12]. The patients in the aerobic group performed an aerobic training using a stationary bike [3 d/wk for 8 weeks]. All subjects in this group were administered the same medicine at the same dose. A fasting blood sample was collected prior to and after 8 weeks of aerobic training from the patients. Serum C-reactive protein [CRP], fibrinogen and rheumatoid factor [RF] were measured using standard methods. There was a significant difference in CRP, fibrinogen and body mass index before and after 8 weeks of aerobic training in the experimental group [P