Bilateral adrenal non-Hodgkin lymphoma type B.

The adrenal localization of a primary non-Hodgkin lymphoma (NHL) is rare. We report a case of a 66-yr-old woman who had severe asthenia, diffuse skin hitching and abdominal pain. The physical examination revealed poor general conditions, irritability, pallor, dehydration and diffuse skin scratching lesions. The abdomen was painful at left hypochondrium and the Giordano's maneuvre was positive on both sides. A peripheral blood smear showed the presence of big rare lymphocytes with dyshomogeneous chromatin and granulated and hyperbasophil cytoplasm. She underwent abdominal ultrasonography which showed the presence of a hypoechogenic ovoidal mass (major diameter 8.4 cm) within the splenorenal left region. The presence of the suprarenal mass was confirmed by computed tomography (CT) scan which showed an enlarged left adrenal gland (8.1 x 6.2 cm) of solid structure. The right adrenal gland was also enlarged and of round shape (4.5 cm). CT scan-guided fine needle aspiration biopsy was then carried out on the left adrenal mass. It revealed the presence of NHL type B with large cells and modest T-lymphocyte reactive component. The patient was treated with three cycles of cyclophosphamide, adriamycin, vincristine and prednisolone. At the end of the third cycle, there was a transient clinical improvement and the hitching disappeared, but the patient worsened rapidly and she died few weeks later.

Eradication therapy with rabeprazole versus omeprazole in the treatment of active duodenal ulcer.

BACKGROUND: Rabeprazole has been demonstrated to be a potent antisecretory agent and has been shown to be clinically effective in the treatment of acid-related diseases. AIMS: It was to determine the efficacy of rabeprazole at 20 and 40 mg in addition to amoxicillin and clarithromycin in the treatment of active Helicobacter pylori-positive duodenal ulcers compared with omeprazole 40 mg. PATIENTS AND METHODS: One hundred and twenty-seven patients were randomised into three treatment groups: 40 patients were treated with rabeprazole 40 mg daily, 42 patients with rabeprazole 20 mg daily and 45 patients with omeprazole 40 mg daily for 10 days. All patients received amoxicillin 1 g twice a day and clarithromycin 500 mg twice a day for 5 days. All patients were re-assessed at least 4 weeks after the end of the treatment. RESULTS: According to the intention-to-treat (ITT) protocol, ulcer healing was observed in 90% of patients in the rabeprazole 40 group, in 85.7% in the rabeprazole 20 group and in 93.3% in the omeprazole 40 group. We observed H. pylori eradication in 90% ITT in the rabeprazole 40 group, in 80.9% ITT in the rabeprazole 20 group and in 88.8% ITT in the omeprazole 40 group. Statistical analysis did not show significant differences among the three groups. CONCLUSIONS: A 10-day rabeprazole 20 mg regimen represents an efficacious and safe regimen for H. pylori eradication and ulcer healing.

Gallbladder benign neoplasms: relationship with lithiasis and cancer (ultrasonographic study).

BACKGROUND: The aim of this study is to clarify the prevalence of gallbladder benign neoplasms, their ultrasonographic appearance and their relationship with gallbladder lithiasis and cancer. METHODS: This study was carried out on 9000 consecutive patients having ultrasound of upper abdomen. Only adenomas and papillomas are considered as true benign neoplasms of the gallbladder. Adenomiomatosis and cholesterol polyps, often erroneously labelled as benign neoplasms, were excluded. Patients were followed-up by ultrasound every three months up to two years. RESULTS: The prevalence of benign neoplasms was 1.19%. Papillomas were found more frequently than adenomas both in males (68.51%) and in females (94.33%). Gallstones were not concomitant with benign neoplasms in any case. Neither stones nor growth of gallbladder benign neoplasms were recorded within the two-year follow-up period. CONCLUSIONS: Papillomas were more frequent than adenomas. No gallstone was concurrent with gallbladder benign neoplasms in our series. However, when gallstones are evidenced at ultrasound, further attention is recommended to discover probable concomitant neoplasms. Papillomas and adenomas more than 1 cm in diameter should be quarterly followed-up, while smaller masses could be six-monthly controlled. Surgery should be indicated for large-sized or rapidly growing masses because of the risk for cancer development.

Five-day triple therapy in Helicobacter pylori-positive duodenal ulcer: an eighteen-month follow-up.

The aim of this study was to compare the efficacy of two different 5-day proton pump inhibitor (PPI)-based triple therapies for Helicobacter pylori (Hp)-positive duodenal ulcers (DUs). Eighty-four patients received pantoprazole (Pan) 80 mg O.D. (once daily) for 1 week; 88 patients received omeprazole (Ome) 40 mg O.D. for 1 week. Patients of both groups received clarithromycin (Cla) 500 mg B.I.D. (twice daily) and amoxicillin (Amo) 1 g B.I.D. for 5 days. All of them were clinically and endoscopically investigated before enrollment (T0) and at 1 (T1), 6 (T2), 12 (T3), and 18 months (T4) after the end of the therapy. Hp status was determined by rapid urease test and by histology. At T1, we observed ulcer healing in 87.5% of the patients and Hp eradication in 83.7% of the Pan group (per protocol [PP]). In the Ome group, ulcer healing was noticed in 95.1% and Hp eradication in 95.1% (PP). We found no statistical differences between the groups (PP). At the end of the follow-up, we found a healing rate of 100% both in the Pan group and in the Ome group; an eradication rate of 98.4% and 100% was observed in the Pan group and in the Ome group, respectively. We found no statistical differences between the groups (PP). Hp eradication was associated with an improvement in the grade of gastritis at T1, remaining unchanged until T4. In conclusion, the efficacy of the Pan treatment was similar to the Ome treatment.

Helicobacter pylori-positive duodenal ulcer: three-day antibiotic eradication regimen.

BACKGROUND: The most widely used treatments for ulcer healing and Helicobacter pylori eradication consist of a 1-2 week regimen of a proton pump inhibitor plus two or three antimicrobials. AIMS: To evaluate the efficacy, safety, cost, and tolerance of a three-day regimen with three antibiotics vs. a 10-day treatment with a proton pump inhibitor or vs. a ranitidine bismuth citrate triple therapy. METHODS: Two hundred and twenty-one patients with endoscopically-proven H. pylori-positive duodenal ulcers were recruited to the study. Recruited patients were assigned to one of the following four regimens: (I) omeprazole 40 mg o.m. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 10 days (OAC: 55 patients); (ii) omeprazole 40 mg o.m. on days 1-5, plus amoxycillin 1 g b.d., clarithromycin 500 mg b.d. and metronidazole 500 mg b.d. on days 3-5 (OACM: 56 patients); (iii) ranitidine bismuth citrate 400 mg b.d. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 10 days (RAC: 54 patients); (iv) ranitidine bismuth citrate 400 mg b.d. on days 1-5, plus amoxycillin 1 g b.d., clarithromycin 500 mg b.d. and metronidazole 500 mg b.d. on days 3-5 (RACM: 56 patients). Fisher's exact test was used to compare data regarding healing and eradication in the four groups. RESULTS: The intention-to-treat eradication and ulcer healing rates for the RACM regimen were 95% and 98%, respectively. Statistically significant differences were observed, relating to the eradication and healing of ulcers, between RACM and either the RAC or OAC regimens. CONCLUSION: The three-day antibiotic therapy with amoxycillin, clarithromycin and metronidazole in addition to ranitidine bismuth citrate is a very effective anti-H. pylori regimen.

Colonoscopy technique with an external straightener.

BACKGROUND: An external straightener for colonoscopy which enables proper compression of the abdomen during the entire examination has been developed. METHODS: Beginning January 1, 1997, patients undergoing outpatient colonoscopy were subjected to either manual abdominal compression or compression with an external straightener. Two hundred patients were divided into two groups of 100 patients each: group A (colonoscopy using traditional methods; 38 men, 62 women, mean age 59.6 years, range 18 to 80) and group B (colonoscopy with the help of the external straightener; 40 men, 60 women, mean age 59.8 years, range 16 to 75). Fifteen minutes after the examination, each patient completed a form that assessed the degree of pain during the procedure (no pain, mild, moderate, severe). RESULTS: The ileocecal valve was reached in 89 cases in group A and 94 cases in group B. The average time required to reach the valve was 9.34+/-4 minutes (range 4 to 25) in group A and 6.97+/-3.37 minutes (range 2 to 21) in group B (p<0.001). With regard to the degree of pain, the results for groups A and B were, respectively: no pain = 25% and 40%, mild = 29% and 34%, moderate = 30% and 20%, severe = 16% and 6% (p< 0.001). CONCLUSIONS: The external straightener reduced examination time and decreased the degree of patient pain compared with traditional methods.

Comparative treatment of Helicobacter pylori-positive duodenal ulcer using pantoprazole at low and high doses versus omeprazole in triple therapy.

BACKGROUND: Helicobacter pylori eradication has become the standard treatment for peptic ulcer disease. H. pylori-eradicating triple therapy with omeprazole plus two antibiotics has been used until recently; however, the efficacy of pantoprazole and antibiotics for H. pylori eradication has not been researched thoroughly until now. The aim of this randomized clinical trial was to verify the efficacy of triple oral therapy comparing the effects of pantoprazole using two different doses versus omeprazole twice daily in H. pylori eradication, in ulcer healing and relapses, and in gastritis improvement. MATERIALS AND METHODS: We enrolled 243 patients with H. pylori-positive duodenal ulcer and randomized them into three treatment groups: 84 patients (group Ome40) were assigned to receive omeprazole, 20 mg twice daily, plus amoxicillin, 1 gm twice daily, and clarithromycin, 500 mg twice daily for 10 days; 79 patients (group Pan40) were treated with pantoprazole, 40 mg daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40; and 80 patients (group Pan80) were treated with pantoprazole, 40 mg twice daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40. RESULTS: Ulcer healing was observed in 81 of 84 patients (96.4%) in group Ome40; in 66 of 79 patients (83.5%) in group Pan40; and in 77 of 80 patients (96.2%) in group Pan80. H. pylori was eradicated in 79 of 84 patients (94%) in group Ome40; in 63 of 79 patients (79.7%) in group Pan40; and in 75 of 80 patients (93.7%) in group Pan80. CONCLUSIONS: We found that 10-day triple therapy with amoxicillin, clarithromycin, and either pantoprazole, 80 mg daily, or omeprazole, 40 mg daily, is highly effective in ulcer healing and is very well tolerated, achieving the 90% cure recommended for an ideal first-line anti-H. pylori positive duodenal ulcer treatment regimen.

Helicobacter pylori-positive functional dyspepsia in elderly patients: comparison of two treatments.

The association of Helicobacter pylori and functional dyspepsia is not well defined. The role of H. pylori on dyspeptic symptoms is still controversial. The aim of this study is to confirm the efficacy of H. pylori eradication by two different commonly used treatment regimens, as well as to examine the improvement of the dyspeptic symptoms by eradicating H. pylori. H. pylori functional dyspepsia is prevalent in people over 60 years old. In this age group we treated 126 patients with bismuth plus metronidazole and amoxicillin (group A, 67 patients) versus omeprazole plus amoxicillin (group B, 59 patients). Results were statistically analyzed utilizing the Wilcoxon signed-rank test, McNemer test and chi-square test; P < 0.05 was considered significant. Two months after the end of therapy we observed an eradication rate of 66.1% in group A vs 64.3% in group B. All treated patients showed improvement in symptomatology. Although there was no significant difference between patients in whom H. pylori was or was not eradicated within the respective groups, when examining all H. pylori-positive patients versus H. pylori-negative posttreatment patients, there was a significant reduction (P < 0.05) in all four symptoms of functional dyspepsia measured. In conclusion, we suggest that patients treated with H. pylori-eradicating therapeutic regimens have an improvement in functional dyspepsia symptoms. We shall prefer the dual therapy as compared to the triple therapy. We believe that eradicating treatment to eradicate H. pylori in the elderly patients with H. pylori-related functional dyspepsia will reduce health care costs by reducing the number of subsequent visits.

Efficacy of pneumatic dilatation for pyloric stenosis: an 18-month survey.

The efficacy of pneumatic dilatation with Rigiflex balloons as a treatment for pyloric peptic stenosis was tested in 18 patients. The patients underwent endoscopic dilatation in one sitting, the size of the balloons being gradually increased for a total of 3 minutes. Patients were also treated with omeprazole in the follow-up period. Pneumatic dilatation of upper digestive tract strictures has proved to be an effective and safe technique, showing remarkable advantages over the traditional surgical treatment. It could represent the first step in a therapeutic approach.

Twelve-month omeprazole vs ranitidine in the treatment of Helicobacter pylori positive patients with healed duodenal ulcer.

We evaluated the results of a 12-month treatment using different regimens of omeprazole at the dose of 20 mg daily (three day week-end treatments and every other day) and of 150 mg nocte of ranitidine on Helicobacter pylori status and on preventing duodenal ulcer relapses in 140 Helicobacter pylori positive patients with healed duodenal ulcer. Only every-other-day omeprazole suppresses Helicobacter pylori after 3 month therapy (p < 0.001), after 6 months (p < 0.001) and 12 months (p < 0.05). After 3 months (T1) no significant effectiveness was found in the prevention of ulcer relapses by omeprazole and ranitidine. After 6 months (T2) a significant reduction of relapses (p < 0.05) was recorded when comparing every- other-day omeprazole to the weekend regimen. After 12 months every-other-day omeprazole treatment significantly reduced the relapses compared with the week-end therapy (p = 0.05) and with ranitidine (p < 0.05).