A Prospective, randomized study comparing 7-day and 14-day quadruple therapies as first-line treatments for helicobacter pylori infection in patients with functional dyspepsia.

OBJECTIVE: Standard triple therapy for Helicobacter pylori has a low eradication rate in Turkey. The aim of this study was to evaluate and compare the effectiveness of 7-day and 14-day lansoprazole, amoxicillin, clarithromycin, and bismuth subsalicylate (LACB) treatment regimens as first-line H. pylori eradication therapies. MATERIALS AND METHODS: This study included 70 patients with symptoms of dyspepsia and a positive H. pylori stool antigen test (SAT). Thirty-five patients received the modified quadruple therapy regimen for 7 days (LACB-7) whereas the remaining 35 patients received the treatment for 14 days (LACB-14). Eradication was assessed by SAT 1 month after the end of therapy. RESULTS: A total of 64 patients completed the therapy. The cumulative per-protocol (PP) and intention-to-treat (ITT) eradication rates were 89% (n = 57/64) and 81.4% (n = 57/70), respectively. Both the PP and ITT eradication rates were superior in the LACB-14 group, compared with the LACB-7 group (PP: 90.6% vs. 87.5%; ITT: 81.4% vs. 80%, respectively), but these differences were not statistically significant (P = 0.689). CONCLUSIONS: Both the 7-day and 14-day first-line LACB therapies provided a high cure rate, were well tolerated, and were equally effective against H. pylori infection in Turkey.

Normalization of the psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in Turkey.

AIM: To construct normal values for the tests of the psychometric hepatic encephalopathy score (PHES) and evaluate the prevalence of minimal hepatic encephalopathy (MHE) among Turkish patients with liver cirrhosis. MATERIALS AND METHODS: One hundred and eighty-five healthy subjects and sixty patients with liver cirrhosis without overt hepatic encephalopathy were included in the study. All subjects underwent psychometric tests, which include number connection test-A and B (NCT-A/B), serial dotting test (DST), line drawing test (LDT), and digit symbol test (DST) in the same day. The variables that affected the results of the test were included in the multiple linear regression models and formulas were constructed to predict the expected results for each tests. RESULTS: The results of all PHES tests, except the LDT in the cirrhotic group were significantly different than center of gravity (CG) (P < 0,001). The score of PHES in the cirrhotic group was -2,18 ± 3,3 (median -2; range: 11 to +4), significantly lower than CG (-0.31 ± 2.18 [median, 0; range, -8 to +5]) (P < 0.001). the cutoff of PHES was set -4 point. Therefore, 19 of the 60 cirrhotic patients were diagnosed with MHE (31.6%). Among the patients with MHE, 11 (11/45, 24,4%) had Child-Pugh classification (CTP) A and 8 (8/15, 53.3%) had CTP B. No differences in age and education years were found between the MHE and non-MHE groups (P > 0.05). CONCLUSION: Turkish PHES normograms have been developed for detecting patients with MHE. Future multicenter national studies are needed to validate widely applicable norms.

Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding.

Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10-20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

Development of Dermatomyositis in a Patient with Primary Myelofibrosis.

It is known that immunologic mechanisms play an important role in the disease process of some patients with idiopathic myelofibrosis. Patients with idiopathic myelofibrosis have an increased incidence of autoantibodies and circulating immune complexes. Dermatomyositis is a disorder of unknown cause, but immune-mediated muscle damage is believed to be important as a pathogenic mechanism. We have a patient who had idiopathic myelofibrosis and developed dermatomyositis during the disease course, a previously unreported combination. Increasing clinicians' awareness of both myelofibrosis and dermatomyositis may provide further insight into a possible relationship of the two conditions.

Transformation of hepatitis B virus-related membranous glomerulonephritis to crescentic form.

We report a case of hepatitis B virus-(HBV) related membranous glomerulonephritis which progressed to crescentic transformation after withdrawal of immunosuppressive treatment. Immunosuppressive therapy probably enhanced HBV replication, and its withdrawal led to a return of immune competence resulting in progression of the glomerulonephritis. Prior screening of all patients for hepatitis B surface antigen, before using immunosuppressive therapy may prevent this complication. The usage of immunosuppressive therapy as a first-line choice in HBV-related glomerulonephritis may result in harmful complications.

Helicobacter pylori eradication treatment reduces the severity of rosacea.

BACKGROUND: A higher prevalence of Helicobacter pylori infection in rosacea patients than in healthy controls has been reported. OBJECTIVE: The aim of this study was to investigate the effect of H. pylori eradication therapy in patients with rosacea. METHODS: Twenty-five rosacea patients and 87 age- and sex-matched healthy controls were included in this study. We detected IgG and IgA antibodies against H. pylori in both groups. An upper gastrointestinal endoscopy and a rapid urease test were performed on the 13 patients with rosacea who accepted this procedure. Amoxicillin 500 mg 3 times daily, metronidazole 500 mg 3 times daily, and bismuth subcitrate 300 mg 4 times daily were administered to patients positive for H. pylori. The severity of rosacea was scored before and after treatment. RESULTS: There was no statistical difference in seropositivity in either group. In H. pylori-positive rosacea patients there was a significant decrease in the severity of rosacea at the end of the treatment as compared with the initial scores. CONCLUSION: Our findings suggest that H. pylori may be involved in rosacea and that eradication treatment may be beneficial.

Collagenous colitis in a patient with Addison's disease: a case report.

Diarrhea is a non-specific symptom which may be associated with Addison's disease and several causes had been demonstrated in the aetiology. We describe a patient with Addison's disease who was suffering from chronic diarrhea for three months. She was diagnosed as having collagenous colitis and successfully treated with Sulphasalazine, 2 g/day. Collagenous colitis is an uncommon cause of chronic diarrhea and the association of collagenous colitis with Addison's disease has not previously been described. We think that collagenous colitis may play a role in the aetiology of diarrhea in patients with Addison's disease and therefore we suggest a full colonoscopic examination in other patients with Addison's disease and diarrhea to determine the incidence of collagenous colitis in the aetiology of diarrhea.

The effects of octreotide in a patient with Nelson's syndrome.

We have administered octreotide, 100 micrograms tid, to a 27-year-old man with Nelson's syndrome. After seven days of therapy, adrenocorticotropin levels fell to 54% of initial values, and some shrinkage of the tumour was observed. This study indicates that octreotide therapy may have a role in the treatment of Nelson's syndrome.

Carcinoid syndrome due to a malignant somatostatinoma.

Somatostatinoma is one of the rarest tumours of the endocrine pancreas. Cardinal manifestations of a somatostatinoma include gallstones, mild diabetes mellitus, steatorrhoea, diarrhoea and dyspepsia. Like any other pancreatic islet cell carcinoma, a somatostatinoma may also produce several different hormones such as adrenocorticotropic hormone, calcitonin, vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin, insulin, and glucagon. In many cases, the clinical picture is dominated by the effect of these other hormones. We present a patient with somatostatinoma in which an immunocytochemical study of the specimens from pancreas and liver showed a weak positive reaction for gastrin besides a strong positive reaction for somatostatin. Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.

Colonic subepithelial collagenous thickening in diabetic patients.

PURPOSE: This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic. METHODS: Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial collagen layers were performed on these biopsies. RESULTS: In diabetic patients who had diarrhea, the subepithelial collagen layer (SCL) was thicker than it was in diabetics without diarrhea (P < 0.05). In diabetic groups, the SCL was thicker than it was in both nondiabetics with diarrhea and those without diarrhea (P < 0.05). There was no statistical difference between nondiabetics with diarrhea and those without (P > 0.05). There was no correlation between collagen thickness, age, and diabetes duration (P > 0.05). CONCLUSIONS: It was concluded that there was a thickening of the colonic SCL in diabetic patients.

The prevalence of thyroid dysfunction among elderly subjects in an endemic goiter area of Central Anatolia.

The prevalence of thyroid dysfunction in the elderly is reported to be markedly high, at least in some Western countries in which iodine intake is sufficient or increased because of recent supplementation of iodine for public health. We therefore wished to investigate the prevalence of thyroid dysfunction among elderly people in an endemic goiter area. The study included 198 subjects over the age of 55 years. It was carried out in two towns 20-30 km, south of Kayseri, Central Anatolia. Questioning on medical history, physical examination and grading of thyroid gland size were performed. Serum TSH was measured by a sensitive immunoradiometric assay. Serum free thyroid hormones and thyroid autoantibodies were measured in the subjects with TSH concentrations below 0.4 mu IU/ml or above 4.5 mu IU/ml on the initial screen. Drinking water was also analysed for iodine content. Twenty-five (12.6%) subjects had either elevated (6.5%) or suppressed (6.1%) serum TSH levels. No patient had clinical hypothyroidism (high TSH and low free thyroxine and free triiodothyronine). Three (1.5%) subjects had clinical hyperthyroidism (low TSH and high free thyroxine and free triiodothyronine). Only one subject was positive for antimicrosomal and antithyroglobulin antibodies. The prevalence of goiter was 25.8%. The iodine level in drinking water was found to be 3 micrograms/L. In conclusion, we believe that the prevalence of thyroid dysfunction in the elderly may depend on the iodine status in the environment. We think that hyperthyroidism due to multinodular goiter is more important than hypothyroidism for elderly people living in an endemic goiter area, probably due to the low frequency of autoimmune thyroid disorders.

Acute adrenocortical failure due to tuberculosis.

A 55-year-old woman presented with acute adrenal failure, active pulmonary tuberculosis and an enlarged adrenal mass which was subsequently removed surgically. Histopathologic examination disclosed adrenal tuberculoma. It was concluded that tuberculosis might result not only in chronic adrenocortical insufficiency but also in acute adrenal failure.

[Comparison of HBsAg, anti-HCV and anti-HDV positivity in diverse groups]. / Degisik gruplarda HBsAg, anti-HCV ve anti-HDV pozitifliginin karsilastirilmasi.

Three hundred eighty three serum samples obtained from various patient groups and health care personnel were tested for HBsAg, Anti-HCV and Anti-HDV by ELISA technique. Anti-HCV antibodies were found 32.4% of chronic haemodialysis patients, 23% of the patients with chronic viral hepatitis and cirrhosis, 8.3% of health care personnel and less frequently detected in other groups. Anti-HDV antibodies were found 23% of the patients with chronic viral hepatitis and cirrhosis, 2.7% of blood donors, 8.1% of chronic haemodialysis patients and 1.3% of the patients who have malignancy. Anti-HDV antibodies were not detected in other groups.