Infective endocarditis and occult splenic abscess caused by Brucella melitensis infection: a case report and review of the literature.

This report describes a patient with prosthetic aortic valve endocarditis caused by Brucella melitensis infection with an initial relapse after apparent recovery due to associated occult splenic abscess. In spite of a prolonged period of recovery (6 months) achieved with splenectomy and antibrucella antimicrobial therapy, a second relapse occurred and cure was achieved after replacement of the infected prosthetic valve and prolonged courses of antibrucella antimicrobial therapy. There is controversy on the optimal therapy of such cases, but this report suggests that successful management requires a combination of medical and early surgical therapy.

Symptomatic, endoscopic and histological assessment of upper gastrointestinal tract in renal transplant recipients.

AIM: To assess the prevalence of gastrointestinal symptoms, endoscopic findings, and histological abnormalities in renal transplant recipients. SETTING: Teaching hospital in northern Jordan. METHODS: Seventy-six renal transplant recipients with stable renal function were interviewed for gastrointestinal symptoms, and underwent upper gastrointestinal endoscopy; gastric antral biopsies were evaluated for inflammatory changes and the presence of Helicobacter pylori. One hundred consecutive patients attending the general medical outpatient for various medical problems served as controls; 41 of them consented to undergo endoscopy and biopsy examination. RESULTS: Upper gastrointestinal symptoms were present in 50% of patients compared to 47% of controls (p=0.80). Endoscopic abnormalities were found in 71% versus 63.4%. One patient in each group had duodenal ulcer. H. pylori were found in 60.5% versus 46.3% (p=0.20), and histological gastritis in 40 (52.6%) with acute inflammatory changes in 22 (28.9%), compared to 21 (51.2%) and 15 (36.6%) controls, respectively. Monilial and cytomegalovirus esophagitis were found in 2 (2.6%) and one patient, respectively. CONCLUSIONS: Prevalence of gastrointestinal symptoms and endoscopic and histological findings in stable renal transplant recipients are similar to those in controls. Also, there was no increase in opportunistic infections of the gastrointestinal tract or of gastric H. pylori in these patients.

The effects of Ramadan fasting on certain biochemical parameters in normal subjects and in type II diabetic patients.

Fasting levels of cholesterol, triglycerides, uric acid, fructosamine and glycosylated hemoglobin were measured in normal and in Type II diabetic subjects before the beginning and at the end of the Muslim month of fasting (Ramadan). In normal subjects, there was a significant increase (P<0.01) in triglycerides and uric acid levels as a result of Ramadan fasting. In diabetic patients, triglyceride levels decreased significantly (P<0.05), while uric acid levels showed a significant increase (P<0.01) as a result of the same type of fasting. There were no significant differences in cholesterol, fructosamine and glycosylated hemoglobin levels before and after fasting in either group. These finding suggest that although this type of fasting is effective in causing considerable changes in certain blood biochemical parameters in normal and diabetic subjects, it has no effect on the glycemic control of either normal or Type II diabetic subjects.

The postcholecystectomy syndrome. A role for duodenogastric reflux.

We have assessed the relationship between dyspepsia and gallstones and evaluated the effects of cholecystectomy on symptoms, endoscopic findings, and degree of duodenogastric reflux. Thirty patients with gallstones were enrolled in our study. Their symptoms, gastroscopic findings, and bile salt concentrations in fasting gastric juice were evaluated before and after surgery. Before cholecystectomy, biliary colic was present in 26 patients and dyspepsia in 20 patients; 16 patients also had biliary colic. After surgery, biliary colic disappeared in all patients. Dyspeptic symptoms improved in 12 patients (40%), 13 (43%) remained the same, and five patients (17%) developed dyspepsia or showed increase in their symptoms, the postcholecystectomy syndrome (PCS). Endoscopic gastritis developed in 50% after surgery compared with 30% before. Benign gastric ulcers developed in three patients, whereas none had been present before. Concentration of bile salts in fasting gastric juice increased from 0.56 +/- 0.4 mM to 1.47 +/- 0.75 mM after cholecystectomy (p < 0.0001). There was a positive correlation between the severity of symptoms in the postcholecystectomy syndrome and the change in the concentration of bile salts in fasting gastric juice (p = 0.0012). These observations suggest that duodenogastric reflux may play a significant role in the pathogenesis of symptoms in the postcholecystectomy syndrome.

Brief report: evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis.

PURPOSE OF THE STUDY: This study was performed to determine the gastrointestinal symptoms, and endoscopic and histopathological findings in patients on maintenance haemodialysis. STUDY DESIGN: Nintey-two patients on haemodialysis were enrolled in this study and 100 consecutive dyspeptic patients referred for endoscopy served as controls. They were interviewed to obtain information regarding GI symptoms and endoscopy was performed and biopsies were taken from antral mucosa for histopathological evaluation and helicobacter identification. RESULTS: Prevalence of GI symptoms in the dialysis group was extremely common (77%); with more cases in those with periods of dialysis longer than 6 months. Endoscopically observed of hiatus hernia was present in 27 patients in the dialysis group versus 14 in the control group (P<0.02). Duodenal ulcers were present in three patients of the dialysis group compared with 16 in the control group (P<0.01). Histologically, chronic superficial gastritis and mucosal atrophy tended to be more common in the dialysed patients, but this difference was not statistically significant. Helicobacter pylori were present in 45 patients in the dialysis group versus 73 in the control group (P<0.01).