Helicobacter pylori and recurrent abdominal pain in children: Is there any relation.

Background: The role of Helicobacter pylori (HP) as a cause of recurrent abdominal pain (RAP) and gastrointestinal symptoms is controversial and there still remains a big debate whether to test and treat or not. Aim: To investigate the correlation between HP infection and RAP as well as other GI symptoms. Methods: We conducted a case control study at the Jeddah Clinic Hospital from January 2009 to December 2010. It included 244 cases (group I) aged 2-16 years with RAP after exclusion of any organic disease. Cases receiving antibiotics, bismuth, H2 antagonists or proton pump inhibitors during last 45 days were excluded. 122 age and gender matched asymptomatic children (group II) were enrolled as controls. Both groups were tested for Helicobacter pylori infection using stool antigen and/ or urea breath test. Results: The mean age of cases was 7.76 ± 3.38 years. 48% of cases were males. There was no significant statistical difference between both groups regarding age and sex distribution, nationality and body weight (BW). 42.6% cases were positive for H. pylori infection in group I and 45% in group II. Comparison between HP positive cases and HP negative cases in group I revealed a statistically significant difference in incidence of vomiting, epigastric pain, history of infected family member and iron deficiency anemia (p=0.001, 0.000, 0.000 and 0.025 respectively). Conclusion: HP infection is documented in more than 40% of both symptomatic and asymptomatic children. There is no association between RAP and HP.

Tratamento do câncer de pulmão localmente avançado / Treatment of locally advanced lung cancer

Dentre as neoplasias malignas, o câncer do pulmão é a segunda causa mais frequente de morte. Em metade dos pacientes, o diagnóstico é feito tardiamente (nos estágios III e IV), e, nessa fase, a terapêutica está voltada principalmente para o tratamento sintomático e a melhoria da qualidade de vida. A maior parte desses pacientes morre de complicações locais, sobretudo decorrentes de obstrução da via aérea. O presente artigo aborda o tratamento dessas obstruções — a causa principal de morbidade e mortalidade nesses pacientes. Fazemos uma revisão anatômica da via aérea para, em seguida, descrever as principais formas de obstrução das vias aéreas por doença maligna. Discutimos as diferentes técnicas utilizadas para esse fim: o desbridamento e a dilatação endobrônquica, a ressecção das lesões com laser, eletrocautério, pinças de biópsia ou a ponta do broncoscópio (core out), assim como a utilização de órteses de vias aéreas. Enfatizamos a importância da melhora da qualidade de vida desses pacientes com a utilização desses métodos, aliviando a dispneia e diminuindo a ocorrência de pneumonias associadas à obstrução brônquica. Ressaltamos que o manuseio dos pacientes com obstrução por invasão intraluminal ou por compressão extrínseca requer uma equipe multidisciplinar com experiência em broncoscopia flexível e rígida e que disponha de equipamentos apropriados e de suporte de terapia intensiva. Ressaltamos ainda a importância do envio precoce dos pacientes para tratamento especializado.

Lung cancer is the second leading cause of cancer death. Approximately half of all lung cancer patients are diagnosed at anadvanced stage (stage III or IV), and the treatment of such patients is aimed primarily at improving quality of life and alleviating symptoms. Most patients with advanced stage lung cancer will die from local complications, primarily from those related to airway obstruction. The objective of this review was to explore practical approaches to airway obstruction, which is the main cause of morbidity and mortality in such patients. We review airway anatomy and describe the various processes of airway obstruction in malignancy. We also discuss methods for alleviating airway obstruction: debridement; endobronchial dilation; laser resection; electrocauterization; core biopsy with forceps and a rigid bronchoscope; and airway stent placement. By alleviating dyspnea and reducing the incidence of pneumonia related to bronchial obstruction, the methods describedhere can improve quality of life in patients with advanced stage lung cancer. We stress the importance of a multidisciplinary approach in cases of intraluminal tumor invasion or extrinsic airway compression. The multidisciplinary team must includeprofessionals with experience in performing fiberoptic and rigid bronchoscopy, as well as having access to the equipment required in order to provide intensive care. In addition, patients should be referred to specialized facilities as early as possible.