Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy.

OBJECTIVE: To compare the clinical outcomes and pathological findings of transperineal ultrasound-guided prostate biopsy (TPUSPB) and transrectal ultrasound-guided prostate biopsy (TRUSPB) in a secondary referral hospital. METHODS: This was a retrospective study of 100 TPUSPBs and 100 TRUSPBs performed in our centre. Pre-biopsy patient parameters (eg, patient age, clinical staging, serum prostate-specific antigen [PSA] level, prostate size, and PSA density), as well as pathological results and 30-day complication and readmission rates, were retrieved from the patients' medical records and compared between the two groups. RESULTS: One hundred TPUSPBs performed from January 2018 to May 2018 and 100 TRUSPBs performed from January 2016 to April 2016 were included for analysis. Mean age did not significantly differ between the groups. The TPUSPB group had a higher mean PSA level, smaller prostate size, and higher PSA density, compared with the TRUSPB group. The overall prostate cancer detection rate was similar between the TPUSPB and TRUSPB groups (35% vs 25%, P=0.123). There were no significant differences between the groups in prostate cancer detection rates after stratification according to PSA density and clinical staging. With respect to complications, no patients developed fever in the TPUSPB group, while 4% of patients in the TRUSPB group had fever and required at least 1-week admission for intravenous antibiotic administration. CONCLUSION: For prostate biopsy, TPUSPB is safer, with no infection complications, and has similar prostate cancer detection rate compared with TRUSPB.

Photoselective vaporisation prostatectomy using a GreenLight High Performance System for patients with bleeding tendency.

OBJECTIVES: To report the results of a modified vaporisation incision technique using a GreenLight High Performance System in the treatment of benign prostatic disease in men receiving anticoagulants. DESIGN: Case series. SETTING: Regional hospital, Hong Kong. PATIENTS: From January 2007 to April 2010, 48 patients with a bleeding tendency or on oral anticoagulants who underwent photoselective vaporisation prostatectomy with a GreenLight High Performance System in the North District Hospital were studied. Data collected prospectively were analysed to determine perioperative and postoperative outcomes, including uroflowmetry parameters, serum prostate-specific antigen level, prostate volume, and complications at 1, 3, 6, and 12 months post-surgery. RESULTS: The patients' mean age was 76 (standard deviation, 7; range 62-94) years. The mean follow-up period was 13 (standard deviation, 9) months. Thirty-six (75%) patients had urinary retention prior to surgery. Bleeding tendencies were due to receipt of aspirin (n=36), two antiplatelet agents (n=6), warfarin (n=4) and clopidogrel (n=1), and to thrombocytopaenia (n=1). Preoperative transrectal ultrasonography showed a mean prostate size of 58 (standard deviation, 30; range, 18-154) mL. Of the patients, 81% were discharged without a catheter and their mean hospital stay was 3 days. Five patients were readmitted for secondary haemorrhage, two had a drop of more than 10 g/L in their haemoglobin level, but only one received a blood transfusion. Mean uroflowmetry parameters, namely, peak flow rate and residual volume, were 8.7 mL/s and 199 mL preoperatively and 14.7 mL/s and 50 mL 1 year after the operation. CONCLUSION: With an ageing population in which patients with various co-morbidities receive anticoagulant/antiplatelet therapy, photoselective vaporisation prostatectomy using a GreenLight High Performance System is a safe treatment option.

Lower urinary tract changes in young adults using ketamine.

PURPOSE: We identified the profile of lower urinary tract changes in ketamine users in the community. In addition, we identified the relative risks of dose, frequency of ingestion and duration of ketamine use for changes in lower urinary tract function. MATERIALS AND METHODS: A mobile medical assessment service was established at specific youth centers, and subjects who were known to social workers and who had a history of ketamine use were invited to participate in health screening. Lower urinary tract function was evaluated using the Pelvic Pain, Urgency and Frequency questionnaire, and uroflowmetry and ultrasonography. RESULTS: Use of ketamine more than 3 times weekly was significantly associated with lower voided volumes. Pelvic Pain, Urgency and Frequency questionnaire scores were significantly higher for ketamine use for more than 24 months compared to use for short durations (7.82 vs 6.00). The scores on the symptom and bother subscales of the Pelvic Pain, Urgency and Frequency questionnaire decreased progressively with increased duration of abstinence. For individuals after 1 year of abstinence the Pelvic Pain, Urgency and Frequency questionnaire scores were significantly lower and voided volumes were higher than those for active users. CONCLUSIONS: Ketamine users with at least a 2-year habit of 3 or more hits per week have altered bladder function that can be recognized and that causes bother. These early functional changes have the potential to normalize after 1 year of ketamine abstinence. This study provides a basis for the development of health promotion material that can be used in the community by welfare workers seeking to encourage drug cessation.

Refractory thrombotic thrombocytopenic purpura and membranoproliferative glomerulonephritis successfully treated with rituximab: a case associated with hepatitis C virus infection.

Plasmapheresis remains the main treatment modality for patients with thrombotic thrombocytopenic purpura. We report a patient who had simultaneous onset of membranoproliferative glomerulonephritis and thrombotic thrombocytopenic purpura. She did not improve after 48 plasmapheresis sessions. A 6-week course of weekly intravenous doses of rituximab was then given. This achieved complete remission of her nephrotic syndrome and improvement in her renal function, so plasmapheresis was ceased. She had a low ADAMTS13 antigen level and a positive ADAMTS13 antibody, both of which reverted to normal after treatment with rituximab. This coincided with a rise in her hepatitis C virus RNA and liver transaminases. Liver biopsies did not reveal active fibrosis. Her hepatitis C virus RNA titre dropped afterwards, and she had no relapses of her thrombotic thrombocytopenic purpura and nephrotic syndrome, for more than 2 years after remission. The simultaneous onset and successful outcomes of both the membranoproliferative glomerulonephritis and thrombotic thrombocytopenic purpura illustrate the usefulness of rituximab. We discuss its use and risks, in the context of chronic hepatitis C infection.

Outcome Evaluation of a Short-Term Hospitalization and Community Support Program for People Who Abuse Ketamine.

Ketamine is a popular recreational drug among young people in Hong Kong. Long-term abuse of ketamine can lead to acute urological and medical issues, which often require immediate care at emergency rooms. Many patients require short-term hospitalization for medical management. This opens a brief time window, within which mental health professionals could engage young people who abuses ketamine in psychosocial, functional, and lifestyle interventions. The Crisis Accommodation Program (CAP) is a short-term hospitalization and community support program that addresses the health care needs of young people who abuse ketamine. During short-term hospitalization, the patient participates in a range of cognitive and psychosocial assessments, motivational interviewing, emotions management, and lifestyle re-design interventions. Upon discharge, social work professionals of non-government agencies continue to work with the patients on their action plans in the community. This evaluation study uses a quasi-experimental non-equivalent group design, in which the outcomes of the treatment group (n = 84) are compared with a comparison group (n = 34) who have a history of ketamine abuse but who have not joined the treatment program. The results confirm that the treatment group showed significant increases in motivation for treatment, reduction in drug use, improvement in cognitive screening tests, healthy lifestyle scores, and self-efficacy in avoidance of drugs over 13 weeks. When compared with the comparison group, the treatment group had significant decreases in anxiety and treatment needs and had moved from pre-contemplation to the contemplation or preparation stage. However, there were no significant changes in outcome measures covering lifestyle or self-efficacy in drug avoidance. Overall, the CAP is effective in reducing drug use, anxiety, and helping patients to move from pre-contemplation to the contemplation or preparation stage of change. The study results suggest that health care professionals can successfully engage young people who abuse ketamine to participate in a package of psychosocial interventions, motivational interviewing, and lifestyle re-design during their hospital stay for management of urological problems. The CAP also highlights the importance of collaboration between hospitals and community social services in the management of addiction.

The prevalence of cardiovascular risk factors in male patients who have lower urinary tract symptoms.

OBJECTIVES: To assess the prevalence of cardiovascular risk factors in men presenting with lower urinary tract symptoms, and their possible correlation with the severity of such symptoms. DESIGN: Retrospective cohort study. SETTING: Specialty clinic, Hong Kong. PATIENTS: A total of 617 men presenting with lower urinary tract symptoms between April 2005 and October 2006. MAIN OUTCOME MEASURES: Presence of cardiovascular risk factors inferred from the prior and current medical and social history as well as physical examination and investigative findings, among patients with International Prostatic Symptom Scores of different severity. RESULTS: Of 617 patients, 268 (43%) had known hypertension and 318 (52%) had a history of smoking. According to the World Health Organization criteria for Asian populations, 396 (64%) patients were considered to be overweight (body mass index > or =23 kg/m(2)). A total of 178 (29%) patients were either known to have or were diagnosed to have dysglycaemia during workup. For dyslipidaemia and hyperuricaemia, the corresponding figures were 331 (54%) and 191 (31%). In total, 264 (43%) patients were newly diagnosed as having dysglycaemia, dyslipidaemia, or hyperuricaemia. Logistic regression indicated that only hyperuricaemia and a smoking history were significant predictors of moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8), with respective adjusted odds ratios of 2.20 (95% confidence interval, 1.12-4.31; P=0.022) and 2.11 (1.24-3.57, P=0.006). Patients with moderate-to-severe International Prostatic Symptom Scores had a statistically higher chance of having at least one cardiovascular risk factor during assessment (P=0.001). CONCLUSIONS: Cardiovascular risk factors were prevalent in male patients who had lower urinary tract symptoms; a large portion of these cardiovascular risk factors were not recognised until their urological consultations. Patients with moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8) had statistically higher chances of having more cardiovascular risk factors.

Prevalence of subclinical infection and transmission of severe acute respiratory syndrome (SARS) in a residential care home for the elderly.

OBJECTIVE: To ascertain the prevalence of subclinical severe acute respiratory syndrome-coronavirus (SARS-CoV) infection and study the transmission of SARS-CoV in a local outbreak at a residential care home for the elderly. DESIGN: Cross-sectional study. SETTING: A residential care home for the elderly in Hong Kong with a local outbreak of SARS. PARTICIPANTS: Residents and staff in the residential care home who had contact with three patients with SARS (residents A and B, and staff C). MAIN OUTCOME MEASURES: Blood samples were tested for total antibodies to SARS-CoV by immunofluorescence antibody test. The transmission of SARS was elucidated based on information from standardised questionnaires, and records of investigation and surveillance by the Department of Health. RESULTS: Among the 90 eligible residents, three died, one moved out, and 19 refused to participate. Of the 32 eligible staff, six refused to participate. None of the remaining 93 participants tested positive for antibody to SARS-CoV. Based on the chronological order, resident A might have transmitted infection to resident B and staff C. Sitting close to the bathroom doorway while resident A took a shower was the only contact of resident B with resident A. The only opportunity for staff C to have contact with body fluids/excreta of resident A was in the handling of rubbish from the resident's room. CONCLUSION: Subclinical SARS-CoV infection was rare in a residential care home for the elderly with an outbreak of SARS. Nonetheless the close working and living conditions for staff and residents in such a home may facilitate transmission of SARS despite vigilant precautionary measures.

Successful treatment of IgA nephropathy in association with low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue type.

Kidney and the urogenital tract are among the various mucosal sites involved in mucosa-associated lymphoid tissue (MALT) lymphoma. We report a case with simultaneous onset of crescentic immunoglobulin (Ig) A nephropathy and gastrointestinal low-grade B-cell lymphoma of the MALT type with kidney infiltration. M-component of IgM lambda was detected in the serum, and the renal biopsy specimen showed monotypic lambda light chain staining in the lymphoma cells but not the glomeruli. The heavy proteinuria and impaired creatinine clearance returned to normal, and microscopic hematuria disappeared 20 months after treatment with chlorambucil as single-agent chemotherapy. This coincided with a complete resolution of the gastric and renal lymphoma infiltration. The close association of both the onset and successful outcome of the two entities thus support their possible causal relationship, and we discuss the possibility of an association of the disturbance of the MALT by the lymphoma cells with the pathogenesis of IgA nephropathy.

Randomized prospective study of the effect of increased dialytic dose on nutritional and clinical outcome in continuous ambulatory peritoneal dialysis patients.

Cohort studies have shown that greater urea (Kt/V) and creatinine clearances (CCr) were associated with better survival in patients on continuous ambulatory peritoneal dialysis (CAPD). The possibility of improved patient outcome with increased dialytic dose remains unknown. We prospectively studied over 1 year the effects of an extra 2-L bag on the outcome of 82 patients undergoing three daily 2-L exchanges for at least 12 months. At 1 year, 36 patients were undergoing 6-L exchanges, whereas 30 patients underwent 8-L exchanges. The increased dialytic dose resulted in increased total weekly Kt/V (TKt/V; 1.82 to 2.02), whereas total weekly CCr (TCCr) was maintained (63.2 to 61.9 L/1.73 m(2)). Control patients had reduced solute clearances (TKt/V, 1.87 to 1.67; TCCr, 64.8 to 54.6 L/1.73 m(2)). The fourth bag exchange resulted in a significant increase in net ultrafiltration (0.83 to 1.51 L/d), whereas the control group also had greater ultrafiltration (0.68 to 1.01 L/d) after 1 year. Although the normalized protein equivalent of nitrogen appearance (nPNA) was stable in the controls, the patients using 8-L exchanges achieved a greater nPNA (1.10 to 1.24 g/kg/d). There was no associated change in serum albumin levels (3.79 to 3.48 g/dL). The hospitalization rate increased in the controls (0.9 to 1.8 admissions/12 mon), whereas it was unchanged in the patients using 8-L exchanges. In conclusion, a 33% increase in dialytic prescription led to increased peritoneal and total clearances. Despite achieving increased nPNA (13%), the serum albumin level was unchanged. However, the increased hospitalization rate observed in the controls was avoided in the group using 8-L exchanges.

Polymerase chain reaction amplification of herpes simplex virus DNA from clinical samples.

The polymerase chain reaction was used to amplify herpes simplex virus (HSV) DNA from 79 clinical specimens from the female genital tract, and the results were compared with cell culture. Combining the polymerase chain reaction with visualization of amplified products using a direct gel analysis, HSV DNA was detected in 38 specimens, six of which were negative for virus by cell culture. Hybridization of the amplified products detected HSV in three other specimens. One specimen was positive for HSV by cell culture but negative for viral DNA by polymerase chain reaction. Specimen purification before the polymerase chain reaction improved the detection of viral DNA. Restriction endonuclease cleavage of amplified DNA seen by direct gel analysis, used to differentiate HSV-1 from HSV-2, was correct in each case. The analysis time using the polymerase chain reaction was 8-10 hours, making this technique potentially valuable in the clinical setting of parturition.

Detection of human parvovirus B19 in early spontaneous abortuses using serology, histology, electron microscopy, in situ hybridization, and the polymerase chain reaction.

OBJECTIVE: To determine whether there is an association between parvovirus B19 infection and early spontaneous abortion at less than 20 weeks' gestation. METHODS: Eighty samples of early spontaneous abortions were analyzed. Each sample was examined histologically for the presence of viral inclusions, and selected cases were analyzed for parvovirus using electron microscopy and in situ hybridization. Polymerase chain reaction DNA amplification for the virus was done in each case. Maternal sera were analyzed for immunoglobulin (Ig) M and IgG parvovirus antibodies and compared with temporally matched controls. RESULTS: Five cases in the study group had evidence of seroconversion for parvovirus, compared with two controls. Products of conception from two of these five cases were positive for virus by polymerase chain reaction amplification, and only one of these two had a characteristic inclusion of parvovirus histologically. Conversely, five chorionic vesicles from mothers who had not seroconverted had histologic changes suggesting parvovirus infection, but all of these cases were negative for parvovirus using in situ hybridization, polymerase chain reaction, and electron microscopy. CONCLUSIONS: Parvovirus B19 DNA was found in two of 80 early spontaneous abortuses. Although viral DNA was detected in two cases, there was no clear evidence that the infections caused fetal death. Neither case showed erythroblastosis with large numbers of inclusions, as is seen in hydropic fetuses with parvovirus infection. In addition, in five cases in which parvovirus infection was not documented serologically or by the polymerase chain reaction, there was erythroid nuclear clearing suggestive of parvovirus B19 inclusions. This indicates that histologic evaluation for parvoviral inclusions is not always reliable in early spontaneous abortuses.

A retrospective study of seven cases of Candida parapsilosis peritonitis in CAPD patients: the therapeutic implications.

BACKGROUND: Candida peritonitis accounts for the majority of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida species were not routinely subtyped in previous studies. The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear. OBJECTIVE: To study the clinical course and outcome of C. parapsilosis peritonitis in CAPD patients. SETTING: Peritoneal dialysis unit in a regional hospital. PATIENTS AND DESIGN: A retrospective study on seven cases of C. parapsilosis peritonitis occurring in a single center over 3 years. RESULTS: The 7 patients included 4 males and 3 females. Their mean age was 62 +/- 11.5 years. Two (29%) were diabetic. Three (43%) had a history of preceding peritonitis and 5 (71 %) had received broad spectrum antibiotic within the previous 1 month. All presented with cloudy dialysate, abdominal pain, and fever. The mean dialysate white cell count was 300 +/- 168/mm3 with a predominance of neutrophils (81.4% +/- 13.1%). The mean time from onset of symptoms to diagnosis was 5.7 +/- 3.1 days. All had been treated with immediate catheter removal within 24 hours of diagnosis and antifungal therapy, including oral fluconazole, intravenous (IV) amphotericin, or their sequential combination. Environmental samplings were negative for C. parapsilosis. The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one peritoneal adhesion (14%), and one mortality (14%). In the end, only two (29%) could resume CAPD. CONCLUSIONS: The outcome of this study group appeared worse than those previously described in the literature, and the optimal treatment for this group of patients remains unclear.

Recombinant human erythropoietin (rHuEPO) therapy has no effect on peritoneal transport in CAPD patients: a short-term study.

While theoretically the vasoconstriction associated with the rise in hemoglobin (Hb) level may potentially alter peritoneal transport characteristics, the effect of recombinant human erythropoietin (rHuEPO) therapy on peritoneal transport in continuous ambulatory peritoneal dialysis (CAPD) patients remains unclear. We have therefore performed a prospective study on the short-term effect of rHuEPO on the peritoneal transport characteristics in terms of the change in corrected dialysate/plasma creatinine (D/Pcr) in the fast peritoneal equilibration test (PET). Eight consecutive CAPD patients started on rHuEPO had fast PETs performed before and 4 to 6 months after the initiation of rHuEPO therapy. Another 8 CAPD patients with stable Hb levels not receiving rHuEPO served as a control group. All patients (study and control) had been on CAPD therapy for more than 3 months upon enrollment, and none had peritonitis during the study period. Patients receiving rHuEPO showed significant increase in Hb level, while the Hb levels of those in the control group remained unchanged. Neither the study nor the control group patients showed significant change in the corrected D/Pcr value over a mean observation period of 5.25 +/- 0.89 months. While rHuEPO appears to be effective in increasing the Hb level in CAPD patients, there is no significant impact on the corrected D/Pcr in the fast PET test observed in this short-term study.

The effects of acute sleep deprivation on performance of medical residents in a regional hospital: prospective study.

OBJECTIVE: To evaluate the effects of acute sleep deprivation on the level of perceived occupational stress and cognitive functioning in a group of medical residents. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PARTICIPANTS: Twenty-one residents who had regular in-hospital on-call duties. MAIN OUTCOME MEASURES: From January to April 2002, participants were asked to complete the Raven Advanced Progressive Matrices (sets I and II) and Occupational Stress Inventory-Revised tests at the beginning of an on-call day. They then repeated the tests towards the end of their on-call duties on their next on-call day, at a mean (standard deviation) interval of 8.9 (2.3) days. Occupational Stress Inventory-Revised test scores were transformed into T-scores to provide information about an individual's scores relative to the scores of participants in a normative sample. RESULTS: The group slept for a mean (standard deviation) of 2.9 (1.0) hours during 29.3 (3.8) hours of on-call duties. Before the on-call duties, participants' mean T-scores for the Occupational Stress Inventory-Revised test ranged from 50.6 to 54.5 for the Occupational Role Questionnaire, 52.0 to 57.0 for the Personal Strain Questionnaire, and 37.3 to 52.3 for the Personal Resources Questionnaire. After on-call duties, apart from a slight increase in Role Insufficiency T-scores (50.6 [5.9] versus 52.1 [6.0]; P=0.044), there was no significant change in all other scales of the Occupational Stress Inventory-Revised test. The scores of the Raven Advanced Progressive Matrices test remained stable after the on-call duties (11.3 [1.2] versus 11.5 [0.8], P=0.129 for set I; 29.9 [5.5] versus 30.2 [6.3], P=0.2 for set II). CONCLUSION: Acute sleep deprivation among medical residents was not associated with any significant changes in both cognitive functioning and level of stress perceived.

Primary hyperoxaluria: a rare but important cause of nephrolithiasis.

We report on a middle-aged man with end-stage renal failure apparently secondary to recurrent renal stones. He developed systemic oxalosis soon after commencing dialysis. The diagnosis of primary hyperoxaluria type 1 was supported by the finding of high dialysate glycolate excretion. The patient subsequently received an isolated cadaveric renal transplant, but the outcome was a rapid recurrence of oxalosis and early graft failure. Although isolated liver or renal transplantation in addition to various adjuvant measures may be considered in the early stage, combined liver-kidney transplantation remains the only definitive therapy for a patient with end-stage renal failure and systemic oxalosis due to hyperoxaluria type 1. This case illustrates the possible late presentation of primary hyperoxaluria type 1 and the poor outcome with isolated renal transplantation after the development of systemic oxalosis. One should thus have a high index of suspicion in patients with recurrent renal stones of this rare, but nevertheless important, entity.

Factors associated with poorly-controlled hypertension in continuous ambulatory peritoneal dialysis patients.

INTRODUCTION: Hypertension is highly prevalent among continuous ambulatory peritoneal dialysis (CAPD) patients and is a major risk factor for cardiovascular complications. This study examines the risk factors associated with poorly-controlled hypertension in CAPD. METHODS: We performed a cross-sectional study of 66 stable adult CAPD patients to evaluate their hypertension control over a period of three to four months and their associations with other clinical and laboratory parameters. RESULTS: The mean age of the patients was 56.7 (plus or minus 1.27) years. Their mean systolic and diastolic blood pressure were 139 (plus or minus 2.59) mmHg and 77 (plus or minus 1.35) mmHg respectively; 71 percent of them were on antihypertensive drugs. Thirty (45.5 percent) patients had high blood pressure greater than 140/90mmHg. Compared with patients with normal blood pressure, patients with high blood pressure received significantly more antihypertensive drugs (p-value equals 0.034) and were more likely to be clinically overloaded (p-value less than 0.001). Multivariate analysis showed that systolic blood pressure was predicted by volume expansion (p-value less than 0.001) while diastolic blood pressure was negatively predicted by age (p-value equals to 0.004). In addition, volume overload was predicted positively by dialysate/plasma creatinine (p-value equals 0.011) and negatively by serum albumin (p-value less than 0.001). CONCLUSION: Clinically-apparent volume overload was associated with poor systolic blood pressure control despite aggressive antihypertensive drug therapy. This finding underlines the importance of fluid control and could provide an explanation of the poor outcome observed in patients with high peritoneal transport.

A retrospective study on efficacy of proton-pump inhibitor-based triple therapy for eradication of Helicobacter pylori in patients with chronic renal failure.

OBJECTIVE: The efficacy of short-course triple eradication therapy has been documented in patients with Helicobacter pylori infection and normal renal function. We have evaluated a one-week proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication in a retrospective review of patients with chronic renal failure. METHODS: We studied 25 patients (mean age 65.1 +/- 2.4 years) with creatinine clearance <30 ml/min/1.73 m2 or serum creatinine level >200 micromol/L (13 on dialysis), who had Helicobacter pylori infection, documented by histological examination or rapid urease test, together with either peptic ulcer disease or severe gastritis. The combination of Omeprazole 20 mg BID or Lansoprazole 30 mg BID, amoxicillin 1 gm BID and clarithromycin 500 mg BID was given for one week, in addition to therapy for peptic ulcers. All patients were re-endoscoped four weeks later. RESULTS: All but one patient (96%) had successful eradication. On repeat endoscopy, all 13 patients with peptic ulcers had healed ulcers. For the 12 gastritis patients, three became normal and nine had persistent gastritis. For patients not on dialysis, the serum creatinine level and creatinine clearance remained stable at two weeks after treatment (303 +/- 37 vs. 330 +/- 36 micromol/l, p=ns; 23.6 +/- 3.4 vs. 26.0 +/- 3.9 ml/min/1.73 m2, p=ns, respectively). CONCLUSION: The short course triple therapy was highly efficacious for Helicobacter pylori eradication in patients with chronic renal failure, with no adverse effect on renal function.