1/465. Molecular relationships of helicobacter pylori strains in a family with gastroduodenal disease. OBJECTIVE: Few studies have examined the genetic relationships of helicobacter pylori strains affecting family members. Our aim was to do so. methods: We characterized H. pylori isolates obtained from members of a single family presenting with various gastroduodenal diseases to examine H. pylori bacterial genetic similarity. Endoscopic evaluation with gastric mapping was performed on each individual to establish clinical and histological disease. Genomic dna extracted from each H. pylori isolate was used to generate dna fingerprints for each strain by REP-PCR. vacA genotypes and cagA presence were established by PCR. RESULTS: gastrointestinal diseases among the five members of this family included gastric adenocarcinoma in a 52-yr-old man (index patient), gastric MALT-lymphoma in the 73-yr-old mother; intestinal metaplasia (IV) and atrophic gastritis in the 48-yr-old brother; intestinal metaplasia (I-III) in the 47-yr-old brother, and a duodenal ulcer scar in the 42-yr-old sister. REP-PCR dna fingerprints of H. pylori isolates from the index patient, his mother, and both of his brothers were identical or highly similar. By contrast, the H. pylori dna fingerprint from the sister was markedly different from the H. pylori dna fingerprints from the other family members. All isolates had the genotype cagA-positive and vacA slb/ml mosaic genotype. CONCLUSIONS: The dna fingerprints of H. pylori strains obtained from members of this family with malignancy or premalignant histological disease were identical or highly similar and markedly different from the H. pylori dna fingerprint from the sibling with duodenal ulcer disease. All H. pylori isolates within the family possessed genetic markers of enhanced virulence (presence of the cagA gene and vacA sl/ml mosaicism). In addition to host genetics and environmental factors, these findings suggest that infection with genetically similar H. pylori strains is a significant factor in determining the clinical outcome of an infection with H. pylori. ( info) |
2/465. Double pylorus. We report a 55-year-old man presenting with postprandial epigastric pain and vomiting. barium meal study suggested two openings from the stomach to the duodenum. endoscopy revealed double pylorus with chronic duodenal ulcer, suggesting the second opening as an acquired one. ( info) |
3/465. Duodenal ulceration into the cystic artery with massive hemorrhage. This is a case presentation of a unique cause of intestinal bleeding. A duodenal ulcer eroded into the superficial branch of the cystic artery, causing massive intestinal hemorrhage. The patient, a 76-year-old woman, presented with left upper abdominal and left back pain secondary to cystic lesions in the pancreas body and tail. Stress after operation and complication of leakage of pancreatic juice after distal pancreatectomy with splenectomy and diclofenac sodium administration may have caused a deep peptic ulcer to erode the cystic artery. We performed a transfixing ligation of the bleeding vessel, serosal suture of ulcer of the gallbladder, and simple closure of the duodenal ulcer with covering greater omentum. There were no serious complications after the operation, and the patient made an uneventful recovery. ( info) |
4/465. Studies on the functional disturbances of the papillary region using a pressure sensor. Investigation of the duodenal papilla and the bile duct by EPCG is essential to diagnose the organic and functional disturbances of the papillary region. We have developed a pressure sensor based on a semi-conductor in order to obtain a more objective observation of pathological conditions in the papillary region. Using a duodenofiberscope, the pressure sensor was placed on the tip of canula, and it was inserted into the papilla and measured the movements of the papillary region. The pressure sensor method was carried out in 18 normal subjects and 69 patients with various diseases. As the result of analysis of wave forms in normal subjects, regular wave form patterns were obtained. In about 71% of cases with biliary diseases irregular wave forms were observed. Irregular wave form patterns were also observed 40% of cases with cholecystolithiasis, while irregular patterns were revealed in 86% cases with choledocholithiasis. The pressure sensor method during for duodenofiberscopy is important diagnostic procedure for the determination of functional disturbances in the papillary region. ( info) |
5/465. Direct sonographic signs of acute duodenal ulcer. Sonography was performed in two patients with acute epigastric pain. Isolated thickening of the duodenal wall with an echogenic line within were considered to be signs of duodenal ulcer in keeping with a suggestive clinical background. The extension of this line beyond the duodenal wall and the periduodenal fluid were indicators of perforation. The images in our two patients indicate the usefulness of ultrasonography when performed carefully in selected cases. ( info) |
6/465. Choledochoduodenal fistula at the anterior wall of the duodenal bulb: a rare complication of duodenal ulcer. A 38 year-old man was admitted to our hospital with the chief complaint of epigastralgia. His laboratory data revealed leukocytosis and increased serum amylase, and abdominal ultrasonography revealed diffuse swelling of the pancreas. Thus, he was diagnosed as having acute pancreatitis. Moreover, abdominal computed tomography showed pneumobilia in the gallbladder and the common bile duct. Gastroduodenal fiberscopy demonstrated peptic ulcer scars around a foramen with smooth margins at the anterior wall of the duodenal bulb. The bile juice flowed from the bottom of the foramen. Endoscopic retrograde cholangiopancreatography revealed the fistula between the common bile duct and the anterior wall of the duodenal bulb, but not the posterior wall. However, there was no pancreatico-biliary maljunction and no stones in the gallbladder or bile duct. This is a rare case of choledochoduodenal fistula at the anterior wall of the duodenal bulb caused by duodenal peptic ulcer disease. ( info) |
7/465. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case. A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course. ( info) |
8/465. Ectopic thyroid in the abdomen: report of a case. Ectopic thyroid tissue can be seen anywhere along the path of the descending glands, but it is rarely seen in the abdominal cavity. An ectopic thyroid was encountered incidentally in the pancreas of a 50-year-old woman who underwent a bilateral truncal vagotomy and pyloroplasty for a duodenal ulcer. There were no signs or symptoms of a thyroid tumor. ( info) |
9/465. cimetidine-associated optic neuropathy. Two cases of optic neuropathy associated with cimetidine therapy are reported. Recovery occurred in both after drug withdrawal. Rechallenge with the same agent totally reproduced the condition in the first case. cimetidine exerts an unequivocal toxicity on the central and peripheral nervous systems. Since its introduction in 1976, it has been used in over 100 million patients, but only 3 cases of optic neuropathy have been reported as far as we know. Although the mechanism of toxicity is still unclear, cimetidine is a well-recognized zinc chelator, and zinc deficiency has been implicated in causing optic neuropathy. Hence, it can be concluded that cimetidine produced this toxicity through its mechanism of zinc chelation. However, close ophthalmic follow-up of such patients is unnecessary, but an unexplained visual deterioration should prompt immediate drug withdrawal. ( info) |
10/465. Malabsorption with progressive weight loss and multiple intestinal ulcers in a patient with T-cell lymphoma. We describe a 52-year-old woman who presented with severe diarrhea, nausea, intermittent abdominal pain and weight loss of 18 kg within ten months. Jejunal and duodenal ulcers were detected by endoscopy and multiple biopsies revealed villous atrophy of the jejunum. However, neither gliadin nor endomysium antibodies were detected and no clinical and histological improvement was achieved after gluten withdrawal. Despite strong clinical suspicion for intestinal lymphoma many unrevealing biopsies were done. The patient developed intermittent septic fever and diagnostic laparotomy revealed jejunal perforation. Partial jejunal resection was performed and histology confirmed the diagnosis of an intestinal T-cell lymphoma without celiac disease. Malabsorption and all intestinal ulcers disappeared during the course of chemotherapy (six cycles CHOP) and the patient recovered remarkably. ( info) |