ABSTRACT
BACKGROUND: A questionnaire was used to record the clinical presentation of functional dyspepsia in relation to Helicobacter pylori infection in a consecutive series of patients sent for upper gastrointestinal endoscopy. Only patients without macroscopic abnormalities in their oesophagus, stomach and duodenum were included. METHODS: The study questionnaire included two questions related to daily life, and the calculation of a symptom score. Biopsy specimens were taken from all patients for histological and microbiological examination, and immunoglobulin G antibodies were also determined. RESULTS: Two hundred and twenty-two patients were H. pylori positive and 182 patients were H. pylori negative. Loss of weight was significantly more common in the H. pylori positive group (P<0.001). Patients with H. pylori infection had a significantly higher overall symptom score compared with H. pylori-negative subjects (P<0.05). In addition, the severity of epigastric and nocturnal pain, heartburn, retrosternal heartburn, and vomiting was significantly higher in H. pylori-positive functional dyspeptic patients, and the influence on daily life and activities was significantly worse. CONCLUSIONS: The combination of retrosternal pain, weight loss, food intolerance and the absence of halitosis signified a 64% accuracy in predicting H. pylori infection. It is not possible to differentiate between H. pylori-positive and H. pylori-negative functional dyspeptics on the basis of clinical presentation and the number of complaints. However, overall symptom score and severity of several symptoms was significantly higher in the H. pylori-positive group.
Subject(s)
Dyspepsia/microbiology , Helicobacter Infections/complications , Helicobacter pylori/isolation & purification , Adult , Aged , Aged, 80 and over , Dyspepsia/physiopathology , Female , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Quality of Life , Surveys and Questionnaires , Weight LossABSTRACT
A case history of a patient showing signs of upper gastrointestinal bleeding is described. Extensive analysis showed that the bleeding was due to a malignant Schwannoma of the stomach with several lymph node metastases. The patient was operated on and is doing well 5 years after surgery. The literature on this rare malignant tumour is reviewed.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Neurilemmoma/diagnosis , Stomach Diseases/etiology , Stomach Neoplasms/diagnosis , Adult , Angiography , Barium , Endosonography , Female , Gastrointestinal Hemorrhage/diagnosis , Humans , Lymphatic Metastasis/pathology , Lymphatic Metastasis/ultrastructure , Microscopy, Electron , Neurilemmoma/complications , Neurilemmoma/pathology , Neurilemmoma/ultrastructure , Stomach Diseases/diagnosis , Stomach Neoplasms/complications , Stomach Neoplasms/pathology , Stomach Neoplasms/ultrastructureABSTRACT
Clinical and immunological data are reported of 12 patients suffering from Wegener's granulomatosis and severe renal involvement. Although 9 patients recovered from their acute illness, a long-term follow-up a relapse occurred in 4 of these 9 patients. Therefore, lifelong follow-up in this group patients seems to be mandatory. Extensive immunological investigations did not provide evidence for humoral mechanisms underlying the pathogenesis of this disease; T lymphocyte subsets in peripheral blood as well as functional reactivity of lymphocytes in vitro were also normal. However, none of the patients was able to mount a primary cellular immune response in vivo. On the other hand, kidney biopsy specimens obtained before the initiation of drug therapy revealed periglomerular and interstitial cellular infiltrations consisting predominantly of T lymphocytes with a ratio Leu 3a (OKT4)/Leu 2a (OKT8) of 5:1. This may indicate that a type IV (delayed-type) hypersensitivity reaction takes place in the kidney. These findings suggest that an abnormal cellular immunoreactivity plays a major role in the pathogenesis of Wegener's granulomatosis.
