Does the urea breath test predict eradication of Helicobacter pylori infection?

BACKGROUND AND AIM: Helicobacter pylori infection is common world-wide and has been linked to development of gastric and duodenal ulcers, gastric adenocarcinoma, and gastric lymphoma. However, antimicrobial resistance has decreased H. pylori eradication rates worldwide. This study aimed to evaluate the effect of -bacterial load on eradication rate. METHOD: This prospective study included 237 consecutive patients who presented to our institution with dyspeptic symptoms and underwent both upper endoscopy and urea breath tests (UBT). The patients were divided into three equal sized groups according to their UBT values. All subjects received a standard triple eradication regimen, followed by a bismuth- based quadruple eradication regimen if triple eradication was not successful. The three groups were compared with respect to age, endoscopic findings, sex, and eradication rates. RESULTS: Our results were consistent with those of previous studies : higher UBT values were associated with failure of standard 14-day triple treatment (p < 0.05). However, in patients who received a quadruple eradication regimen, differences between groups were not significant (p = 0.434). There was no relationship between UBT values and gastric pathologies (p = 0.751). Age and sex also did not differ significantly between groups (p = 0.061). CONCLUSIONS: Our study and others have found that high bacterial loads are negatively associated with achievement of eradication with triple treatment. However, differences between groups were not significant in patients who received a quadruple eradication regimen. Comparisons of treatment results according to bacterial density may be informative. The importance of H. pylori density should be further evaluated with new treatment protocols.

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging / Diagnóstico incidental de trombosis tumoral con FDG PET/TC

Objective. Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. Materials and methods. Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). Results. The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n = 7) followed by the portal (n = 5), renal (n = 3), splenic (n = 1), jugular (n = 1), common iliac (n = 1) and ovarian vein (n = 1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40 ± 4.56 and 13.77 ± 6.80, respectively. Conclusion. Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients (AU)

Objetivo. Se presentan los datos clínicos de pacientes con trombosis tumoral (TT) detectada incidentalmente en estudios FDG PET/TC, y se determinan su prevalencia y sus características metabólicas. Material y Métodos. De 12,500 exploraciones consecutivas PET/TC realizadas en pacientes con tumores malignos, se analizaron de forma retrospectiva las imágenes PET/TC de 15 pacientes con TT como un hallazgo incidental. Se realizaron un análisis visual y un análisis semicuantitativo de las exploraciones PET/TC. El patrón de captación de FDG en el vaso afecto, evaluado por análisis visual, fue lineal o focal. En el análisis semicuantitativo se midió la actividad metabólica usando SUVmax, dibujando regiones de interés en el sitio de la trombosis y en el tumor (si existía). Resultados. La prevalencia de TT fue 0.12%. Quince pacientes tenían diversos tumores malignos incluyendo riñón (1), hígado (4), páncreas (2), estómago (1), colon (1), linfoma no Hodgkin (1), leiomiosarcoma (1), endometrio (1), ovario (1), melanoma maligno (1) y parótida (1). Se identificaron 19 vasos con TT en 15 pacientes. Tres pacientes tenían más de un vaso afecto. El vaso más frecuentemente afectado fue la vena cava inferior (n = 7), seguido de porta (n = 5), renal (n = 3), esplénica (n = 1), yugular (n = 1), ilíaca común (n = 1) y venas ovárivas (n = 1). El patrón de captación de FDG fue lineal en 12 y focal en 3 pacientes. El SUVmax medio en el TT y en los tumores primarios fue 8,40 ± 4,56 y 13,77 ± 6,80, respectivamente. Conclusión. Trombosis tumoral oculta en diversos tumores malignos y en diferentes localizaciones se encontró incidentalmente en un 0,12%. Casos interesantes fueron el melanoma maligno y el carcinoma de parótida. La TT en la vena ovárica se describe por primera vez mediante FDG PET/TC. Basado en el patrón lineal captación de FDG y el elevado valor SUVmax, la PET/TC puede detectar con exactitud la TT oculta, ayudar en la evaluación de la respuesta al tratamiento, contribuir en la correcta estadificación del tumor y también puede proporcionar información adicional sobre la supervivencia en pacientes oncológicos (AU)

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging.

OBJECTIVE: Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS: Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS: The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION: Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.

FDG PET/CT imaging in prostate adenocarcinoma presenting as isolated brain metastases of unknown origin / Imagen FDG PET/TAC de adenocarcinoma de próstata presentada como metástasis cerebral aislada de origen desconocido

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A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder / Un caso de metástasis cerebrales y leptomeníngeas de un carcinoma urotelial de vejiga

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases (AU)

Las metástasis cerebrales del carcinoma urotelial de vejiga son poco habituales y, en particular, las metástasis leptomeníngeas son extremadamente raras, siendo pocos los casos descritos en la literatura. Presentamos un hombre de 45 años con metástasis cerebral como primera manifestación secundaria de un carcinoma urotelial de vejiga seguido de metástasis leptomeníngeas sin otra afectación sistémica. Once meses después del diagnóstico de un carcinoma urotelial de vejiga (T2N0M0), se detectaron metástasis cerebrales por RM. El estudio de estadificación con FDG PET/TC no demostró captación anormal en otra parte del cuerpo a excepción del cerebro. El examen histopatológico de una lesión cerebral demostró metástasis del carcinoma urotelial. Dos meses después, una RM descubrió metástasis leptomeníngeas. La situación clínica del paciente se deterioró gradualmente, y falleció 3 meses después del diagnóstico de las metástasis leptomeníngeas (AU)

A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder.

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases.