Ultrasound-Guided Femoral Nerve Blockage in A Patellar Dislocation: An Effective Technique for Emergency Physicians.

BACKGROUND: Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED). CASE REPORT: A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. The initial physical examination and plain radiography showed a patellar dislocation in the right knee. We performed an ultrasound-guided femoral nerve blockage to provide a pain-free and comfortable patellar reduction. To our best knowledge, there is no manuscript except an old case series about use of the ultrasound-guided femoral nerve blockage in the management of patellar reduction in the medical literature. Procedural sedation is the preferred method used for this purpose in ED, but these medications need to be closely monitored because of their potential complications, such as nausea, vomiting, allergic reactions, and respiratory depression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound-guided femoral nerve blockage gave rapid and effective pain control without any complication during the reduction in this patient. Therefore, we suggest this technique be used for pain management during the reduction of a dislocated patella in the ED.

Case Report: Ultrasound-Guided Infraclavicular Brachial Plexus Block for a Case with Posterior Elbow Dislocation.

BACKGROUND: The interest in regional anesthesia procedures for the management of upper-extremity emergencies has increased. Toward that end, supraclavicular, interscalene, or infraclavicular approaches, with or without ultrasound guidance, are used for brachial plexus nerve blocks. Although many studies have reported on the use of ultrasound-guided supraclavicular and interscalene brachial plexus blocks for upper-extremity dislocations, very few studies have reported on the use of ultrasound-guided infraclavicular brachial plexus blocks. CASE REPORT: We present an adult patient with posterior elbow dislocation that is treated with reduction after applying an ultrasound-guided infraclavicular brachial plexus block. Additionally, we describe the infraclavicular block in detail and demonstrate the technique using images. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Based on our experience, the ultrasound-guided infraclavicular block is a fast, safe, and efficient anesthesia technique that can be an excellent alternative to sedoanalgesia and other brachial plexus blocks for the management of elbow dislocations in the emergency department.

Surgically Confirmed Intra- and Extratesticular Hematoma Clinically Mimicing Epididymo-Orchitis and Radiologically Mimicing Traumatic Torsion.

BACKGROUND: Scrotal blunt trauma may result in injuries, such as testicular rupture, dislocation, torsion, hematoma, spermatic cord injury or contusion, and epididymal, scrotal, and urethral injuries. Ultrasonography (US) has a crucial role in the evaluation of those kinds of pathologies. Early diagnosis of testicular rupture may lead to the salvaging of the testicle by prompt surgical exploration within 72 h. CASE REPORT: A 21-year-old male with right scrotal swelling and pain complaints was admitted to another hospital one month ago. Epididymo-orchitis was diagnosed and the patient was given medical treatment. The patient was admitted to our emergency service with ongoing complaints. The patient stated that the pain and swelling suddenly developed after prolonged marching. On US, a large hematoma was detected between the leaves of the tunica vaginalis, and rupture from the lower pole was diagnosed. On color Doppler US, no vascularity was observed in the heterogeneous testicular parenchyma. Traumatic torsion was primarily suggested. Intraoperatively, an extratesticular hematoma, hematocele, and rupture were confirmed but torsion was not found. Because the hematoma entirely replaced the normal parenchyma, orchiectomy was performed. CONCLUSIONS: Testicular rupture may occur even after moderate sportive action such as prolonged marching. If any delay occurs in diagnosis and/or operation, the coagulum may replace the entire parenchyma. We think that US and clinical findings may sometimes mislead the physicians and cause misdiagnoses, such as inflammation or torsion. In this paper, we present a complex delayed diagnosed example case of testicular rupture clinically mimicing epididymo-orchitis and radiologically mimicing traumatic testicular torsion.

PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms.

Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.

Sonographic measurement of diuretic-induced renal length changes: are they correlated with renal function?

OBJECTIVES: The purposes of this study were to prospectively identify diuretic-induced renal length changes and to determine whether the percentages of the renal length changes allow estimation of the differential renal function. METHODS: Twenty-three children (14 boys and 9 girls; mean age, 7.83 years) who were undergoing technetium Tc 99m diethylenetriamine pentaacetic acid or technetium Tc 99m mercaptoacetyltriglycine diuretic renography were included in this study. Renal lengths were measured by sonography just before and 15 to 20 minutes after diuretic injection. The Spearman test was used to assess the correlation between renal length increases due to diuretic injection and the differential renal function. RESULTS: The mean renal lengths ± SD measured before and after diuretic administration were 91.52 ± 20.87 and 95.38 ± 21.46 mm, respectively. The increase in renal length after diuretic administration was statistically significant (P < .001). There was a positive correlation between the renal length change and functional status (P = .006). CONCLUSIONS: Renal length may change after diuretic injection according to the functional status, and the sonographic measurements of these changes may be used as an alternative to other imaging methods in estimation of renal function.

Pararectal mass: an atypical location of splenosis.

Splenosis is the autotransplantation of splenic tissue resulting from the dissemination of cells from the pulp of the spleen after splenic injury or splenectomy. Implants can be found anywhere in the peritoneal cavity, especially on the serosal surfaces of small and large bowel, in the mesentery and diaphragm, implanted in visceral organs, within the thorax and brain, and in surgical scars and may vary in number, shape, and size. We described the sonographic, computed tomography and magnetic resonance imaging findings of pararectal splenosis in a 23-year-old man. The lesions appeared as multiple, well-circumscribed, small, round, homogenously solid masses of different sizes at the retrovesical and pelvic region detected during the imaging workup of Behçet disease.

Proton MR spectroscopic features of the cisternal segment of the trigeminal nerve in patients with trigeminal neuralgia: A pilot study.

PURPOSE: To investigate normal quantitative proton magnetic resonance spectroscopy (MRS) features of the cisternal segment of the trigeminal nerve and evaluate possible metabolite concentration differences in the affected and unaffected nerves of trigeminal neuralgia patients. MATERIAL AND METHODS: A total of 33 consecutive patients who underwent a MR study of the internal auditory canal/posterior fossa and dedicated trigeminal nerve multivoxel MRS were enrolled. Measurements of N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), myoinositol (mI), glutamate-glutamine (Glx) concentrations, and ratios of NAA-to-Cr, Cho-to-Cr, and Cho-to-NAA were automatically calculated by the dedicated software. Vascular conflicts were also recorded. RESULTS: The mean Cr concentration was significantly higher on the affected sides in all parts of the nerve (p < 0.05), while the mean NAA concentration was significantly higher in only the distal portion (p = 0.04). Mean mI concentration was significantly higher in the middle and distal parts (p < 0.05). NAA-to-Cr ratio was significantly higher in the proximal and middle parts (p < 0.05), while Cho-to-Cr ratio was significantly higher only in the middle portion (p = 0.028). Finally, the Cho-to-NAA ratio was significantly higher only in the distal portion (p = 0.04). Vascular conflicts were observed in 24 patients (72.7%), and in 20 of them (60.6%) the conflict was on the same side as the neuralgia symptoms. CONCLUSION: Although the detected statistical relationships were variable in the spectroscopic measurements, metabolite concentrations and ratios were successfully exhibited in all patients. Features of a normal trigeminal nerve were able to determine by MRS. All calculated metabolite concentrations were higher in the affected nerves; however, only some of them were statistically significant. No statistically significant relationships were found between the MRS measurements and nerves with and without vascular compression.

Significance of detectable hepatitis B virus DNA in liver allograft tissue in long-term follow-up of liver transplant recipients.

Background and Aim: The objective of this study was to evaluate the long-term presence of hepatitis B virus (HBV) DNA in the liver grafts of liver transplant patients who received hepatitis B immunoglobulin (HBIg) plus oral antiviral hepatitis B virus prophylaxis and had negative HBV serum markers. Materials and Methods: Patients aged 18 years or older who underwent liver transplantation for HBV-related liver disease, had negative serum viral markers, and had a liver biopsy at least 3 years after liver transplantation were eligible for this study. Clinical, serological, and pathological data were retrospectively obtained from medical records. The HBV DNA of liver biopsy specimens was assessed using the polymerase chain reaction technique. Results: A total of 150 patients were included. A positive HBV DNA result was seen in 18 (12%) of the liver biopsies. The presence of intrahepatic HBV DNA was not associated with pre-transplantation serum viral markers, type of pre- or post-transplantation antiviral treatment, or post-transplantation immunosuppressive treatment. Conclusion: The findings suggest that while treatment with HBIg plus oral antiviral as post-transplantation HBV prophylaxis may result in a percentage of patients with persistent HBV DNA in the graft, the presence of HBV DNA in the liver graft may not be related to clinical HBV recurrence.

Ulnar artery aneurysm in a patient with Behçet's disease.

Behçet's disease is a systemic disease characterized by oral aphthosis, genital ulcers, ocular lesions, gastrointestinal, musculoskeletal, neurological and major vessel involvement. Arterial involvement, aneurysms and arterial thrombosis have been reported in 1.5-3% of patients. In this case report, we present a patient with ulnar arterial aneurysm associated with Behçet's disease.

Is there a relationship between oxygen saturation and MRI-induced anxiety? A prospective study.

PURPOSE: To prospectively examine the possible relationship between oxygen saturation changes and anxiety during MRI examinations. MATERIAL AND METHODS: One hundred and fifty randomly-selected patients referred to our department for MRI examination were included. Participants were asked to complete the Spielberger State and Trait Anxiety Inventory (STAI) to monitor subjective evaluation of anxiety. Both state (STAIs) and trait (STAIt) anxiety levels were recorded as pre-MRI scores. Following the inventory, oxygen saturation levels were measured before, during and immediately after an MRI scan. The patients completed the STAI again immediately following the procedure, and the post-MRI scores were recorded. The scan duration and examined body part were also noted. RESULTS: Ninty-one patients (60.7%) were female and 59 (39.3%) were male. Mean age was 43.68 ± 15.59 years. One hundred and thirty-one of them were head-first examinations, while 19 of them were foot-first, in reference to position on the table. Statistically significant relationships were found between pre- and mid-MRI oxygen saturation levels and mid- and post-MRI oxygen saturation levels. Additionally, mid-MRI saturation levels were significantly lower compared to pre- and post-MRI saturation levels (p = .001 for both measurements). The mean pre-MRI STAIs score was 35.6 ± 10.14, while the mean post-MRI score was 36.45 ± 9.92. The mean pre-MRI STAIt score was 44.01 ± 7.76, and post-MRI score was 44.39 ± 7.75 in the study group. There was no statistically significant relationship between pre- and post-MRI STAI scores. No significant correlation was found between oxygen saturation levels and STAI scores. CONCLUSION: To investigate a possible relationship between oxygen saturation changes during MRI examinations and MRI-induced anxiety, we designed a prospective study. We detected statistically significant lower oxygen saturation levels during the examination compared to pre- and post-MRI levels. However, no statistically significant relationship was found between the oxygen saturation decrease and pre- and post-MRI STAI scores.

Patients with bulbar papilla and choledocholithiasis and their endoscopic management.

BACKGROUND/AIMS: This study presents the endoscopic management of twenty-one patients with biliary stones, deformity at the duodenal bulb, and a flat shaped papilla ectopically located at duodenal bulb. METHODOLOGY: Most of the patients were male with a mean age of 53.9 +/- 9.6 years. In four (19%) of the 21 patients stenotic parts in the bulbus were dilated with TTS balloons, thus allowing ectopic papillae to be reached in all of the cases. Papillary orifice and distal CBD were dilated with balloons from 4 mm diameter and increasing the diameter of the balloons stepwise to 6 to 15 mm. RESULTS: In 20 (95%) the patients, the stones could be extracted in either the first or subsequent endoscopy session as the cholangiography. In one patient, retroperitoneal perforation in the intrapancreatic segment of the CBD occured after dilatation of CBD with a 15 mm balloon, and an operation was necessary. CONCLUSION: The shared features which may constitute a unique clinical entity of the presented cases are 1) male gender, 2) bulbar papilla, 3) flat appearance of the major papilla endoscopically 4) deformed bulbus, and 5) presence of stones in the CBD. Bile duct stones can be treated with endoscopic balloon dilatation of the distal CBD and papilla.

The Relationship between Corpus Callosum Morphometric Measurements and Age/Gender Characteristics: A Comprehensive MR Imaging Study.

OBJECTIVE: The objective of the study was to examine a possible relationship between morphometric corpus callosum (CC) measurements, age, and gender characteristics using MR images. MATERIALS AND METHODS: The medical data and MR examinations of 436 consecutive subjects were retrospectively reviewed. The CC thickness from five different sites, and additionally splenium length, height, and total length of the CC, and the splenium index (SI) were measured with a mid-sagittal T1-weighted sequence. Those measurements were compared with age and gender characteristics. RESULTS: A weak but statistically significant negative correlation was found between age and thicknesses of genu and all body portions of CC (P = ≤0.001 for all, r = -0.32 for genu, r = -0.317 for B1, r = -0.328 for B2, r = -0.328 for B2, and r = -0.194 for B3 and B4). There was a weak but statistically significant positive correlation between age and the lengths of CC and splenium (P ≤ 0.022 for both, r = 0.112 for CC length and r = 0.11 for splenium length). The second part of the body (B2) was thicker in females (P = 0.014). On the other hand, the CC and splenium lengths were greater in males compared to females (P = 0.029 for both). CONCLUSION: We designed a comprehensive MRI study to investigate a possible relationship between normal morphometric CC measurements in 436 healthy subjects. We preferred splenium length and SI as the main splenium measurements instead of direct splenium thickness, due to discrepancies regarding splenium measurement methods in the medical literature. There was a wide spectrum of results, and we compared those results with existing medical literature.

Effect of gadolinium concentration on temperature change under magnetic field.

Gadolinium based contrast agents (GBCAs) were found to play a role in nephrogenic systemic fibrosis in patients with and without renal impairment. Therefore, preserving the structural stability of GBCAs to reduce their propensity to liberate Gd3+ is of utmost importance. This study evaluates the effect of gadolinium concentration of GBCAs on solution temperature under magnetic fields. It is hypothesized that presence of gadolinium will lead to temperature changes of its solutions under magnetic field, and this change will depend on concentration. In this study, GBCAs were diluted to concentrations of 0.6, 1.2, 1.8, 2.4 mMol/L. A 10mL preparation in pure water, simulated body fluid (SBF), and plasma was scanned at 3T following a soft tissue neck protocol, and their temperatures were measured. Findings revealed that concentration of GBCA had significant effect on temperature change in all dilution media. Type of commercially available GBCA had an effect only in SFB and plasma. Evaluation of correlation between conditional stability constant (Kcond) and temperature difference (ΔT) revealed that in water and SBF there exists a positive correlation between Kcond and temperature variation. Collectively, GBCAs can cause local temperature variations when administered into patients, and can affect dissociation of gadolinium from its chelates, which should be investigated in a further study.

Is visceral obesity associated with colorectal cancer? The first volumetric study using all CT slices.

PURPOSE: We aimed to examine the possible relationship between abdominal adiposity parameters and the presence of colorectal cancer (CRC) and between these adiposity parameters and various histopathologic findings of the tumor. METHODS: A total of 60 control subjects and 111 CRC patients, 63 with early-stage and 48 with advanced-stage disease, were enrolled. Medical data and abdominopelvic computed tomography (CT) examinations of each study group were retrospectively reviewed. Abdominal adiposity parameters, including visceral adipose tissue (VAT) volume, subcutaneous adipose tissue (SAT) volume, and total adipose tissue (TAT) volume, were calculated on all slices of the CT examinations with specialized software, and results for each study group were compared. Adiposity parameters were also compared with tumor histopathologic findings. RESULTS: We found lower VAT and higher SAT volumes in advanced-stage CRC patients, compared with the early-stage group. However, this relationship was not statistically significant (P = 0.721 for VAT and P = 0.432 for SAT volumes). We detected significantly lower VAT and SAT volumes in the early-stage CRC group compared with the control group (P = 0.014 for both). There was no significant relationship between TAT volumes and the study groups (P = 0.06). No statistically significant relationship was detected between adipose tissue parameters and histopathologic features of the CRC group (P > 0.05). CONCLUSION: We found statistically significant lower VAT and SAT volumes in patients with early-stage CRC compared with the control group. Volumetric adipose tissue measurements may be more accurate than area measurements and can easily be performed on abdominopelvic CT examination, which is the routine imaging modality for CRC patients.

The cognitive fusion prostate biopsy using a smart phone in the diagnosis of prostate cancer. / Biopsia de próstata cognitiva utilizando un dispositivo móvil.

OBJECTIVES: In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP_MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results. METHODS: Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP_ MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP_MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated. RESULTS: Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules). CONCLUSIONS: In the advanced hands with our new technique, the CFPB using prebiopsy MP_MRI-P seems to be an effective method to detect Pca and significant Pca.

OBJETIVOS: En este estudio de investigación diseñamos una técnica de biopsia de próstata (BxP) con fusión cognitiva (FC) (BxPFC) mediante el examen de la RMN multiparamétrica (RMNmp) de la próstata en un dispositivo móvil cerca del aparato de ecografía transrectal (ETR) y examinamos los resultados.MÉTODOS: Entre enero de 2011 y enero del 2017 se incluyeron en el estudio un total de 344 varones sometidos a BxP. El Grupo 1 hizo una BxP guiada por ecografía transrectal estándar que tenía un mínimo de 12 muestras. El Grupo 2 fue sometido a BxPFC utilizando un dispositivo móvil para evaluar las imágenes de la RMNmp de próstata cerca del aparato de ecografía transrectal. Se tomaron un mínimo de 12 muestras + 1-3 dirigidas de forma cognitiva. Se evaluaron y compararon la detección de CaP y de CaP significativo entre los grupos. También se evaluó el efecto de los hallazgos de la RMNmp de próstata sobre la detección de cáncer de próstata y CaP significativo. RESULTADOS: Los grupos 1 y 2 incluyeron 138 y 206 pacientes respectivamente. Después de la BxP, se detectaron 45(32,8%) pacientes con CaP y 33(23%) con CaP significativo en el grupo 1, y 74(35,9%) y 60(29%) pacientes en el Grupo 2, respectivamente (p=0,001 para ambos). Los valores más altos de PIRADS se asociaron con una detección significativa de CaP y CaP significativo (p=0,004 y 0,002). La presencia de un nódulo en la RMNmp se asocia con una detección significativa de CaP y CaP significativo (p=0,001 y 0,001). Especialmente, cuando el valor del PSA era <10 ng/ml, el PIRADS más alto y existía un nódulo en la RMN mp el diagnóstico de CaP y CaP significativo era significativamente mayor (p=0,02 y 0,019 para PIRADS, y p=0,01 y 0,042 para nódulos). CONCLUSIONES: Con nuestra nueva técnica en manos expertas, la BxP con fusión cognitiva utilizando las imágenes de RMNmp previa parece ser un método efectivo para detectar CaP y CaP significativo.

Distribution characteristics of combat-related shrapnel and relationship to weapon type and conflict location: Experience of an operational field hospital.

BACKGROUND: The aim of this study was to investigate the characteristics of shrapnel distribution in the body and a possible relationship to the type of weapon and type of location of the conflict. METHODS: The records of 246 patients admitted to a level-III trauma center with any kind of firearm injury were examined retrospectively. Ninety patients who had at least 1 radiologically-proven piece of shrapnel in their body were included in the study. For the purposes of the study, the body was divided into 5 regions (head/neck, thorax/back, abdomen/pelvis/waist, upper extremities, and lower extremities) and shrapnel distribution was noted according to these divisions. Medical data and detailed information regarding the weapon type (long-barreled weapon, rocket-propelled grenade [RPG], or improvised explosive device [IED]), conflict location (residential or rural area), and all radiological examinations (radiography and/or computed tomography) were carefully reviewed. The relationship between these variables and the shrapnel distribution in the body was investigated. RESULTS: No statistically significant differences were seen between weapon type and shrapnel distribution (p<0.05), except a significantly higher percentage of head/neck region shrapnel injuries as a result of RPG and IED injuries (p=0.002). There was no statistically significant relationship between the shrapnel distribution characteristics and conflict location, classified as either residential or rural (p<0.05). CONCLUSION: Secondary blast injuries induced by penetrating shrapnel are the most common type of explosion- and combatrelated injuries. In the current study, a significantly higher rate of head/neck region shrapnel injuries was observed in RPG and IED injuries compared with long-barreled weapon-induced injuries. The prim.

Analyses of combat-related injuries to the maxillofacial and cervical regions and experiences in an operational field hospital.

BACKGROUND: With the changing conditions of war, maxillofacial injuries are observed more frequently. Particularly in urban areas, high-energy explosive devices (HEEDs), such as improvised explosive devices, are often used alongside long-barreled weapons (LBWs). It is important to use trauma scoring systems and a multidisciplinary approach for medically and accurately responding to the trauma patient in a timely manner. This study aimed to compare the Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS) between injuries sustained by LBWs or HEEDs and to share experiences of an operational field hospital. METHODS: Medical data of 84 patients admitted to an operational field hospital with maxillofacial and cervical injuries sustained by LBWs and HEEDs between July 27, 2015, and July 22, 2016 were reviewed. MCIS and MFIS scores were calculated for all patients; records of the qualifying patients were studied for the Glasgow Coma Scale (GCS) scores and injury sites. The patients were divided into two groups according to the device/weapon causing the injury: injuries sustained by LBWs in group I and those sustained by HEEDs in group II. RESULTS: All patients were males, with a mean age of 28.75 (range 20-58) years. The average GCS score was 13.4, but it was lower than 15 in 16 (19%) of the patients. There was no statistically significant difference in MCIS scores between the LBW and HEED groups (p=0.206). In addition, there was no statistically significant difference in MFIS scores between the LBW and HEED groups (p=0.238). CONCLUSION: Maxillofacial and cervical region injuries are increasing in modern conflicts that are usually located in urban areas. Injuries sustained by HEEDs as well as those sustained by LBWs in the maxillofacial area are morbid and mortal. Rapid and comprehensive intervention is life-saving and helping the patient to further trauma treatment.

Fecal Elastase Levels Predict Honeycombing in Pancreas Detected with Endoscopic Ultrasound.

Background and Study Aims: We aimed to demonstrate the association between fecal elastase levels and Rosemont categories in patients with chronic changes in pancreas detected with endoscopic ultrasound. Patients and Methods: Patients were selected consecutively from endosonography examinations performed for upper gastrointestinal subepithelial lesions and for pancreas evaluation. Pancreas imaging findings were categorized according to the Rosemont criteria using echoendoscope. Patients who were indeterminate of, suggestive of, and consistent with chronic pancreatitis were included in the study. Fecal elastase measurements were performed after the patients were qualified to participate in the study according to endosonography findings. Results: Seventy patients were included in the study. 54 of them were male. Mean age of the patients was 51.7 ± 10.2 year. There were 36 patients in the indetermine group for chronic pancreatitis. Mean fecal elastase level was 507.1 ± 14.6 µg/g in the indeterminate group. There were 24 patients in the suggestive group of chronic pancreatitis. Mean fecal elastase level was 400.4 ± 121.4 µg/g in the suggestive group of chronic pancreatitis. There were 10 patients, in the consistent group with chronic pancreatitis. Mean fecal elastase level was 134.8 ± 86.1. The difference between the three groups of fecal elastase values was statistically significant compared with Kruskal Wallis test. Ordinal logistic regression analysis showed that there was a significant relation between endosonografic categories and fecal elastase values with Nagelkerke value of 0.704. Conclusions: Fecal elastase levels of each of the endosonographic categories were significantly different from each other. Also, fecal elastase values can predict chronic changes in pancreas detected with endoscopic ultrasound.

Improving the standard sequential treatment of Helicobacter pylori with either extended treatment or by adding bismuth.

BACKGROUND AND STUDY AIMS: Standard sequential treatment for Helicobacter pylori (H. pylori) eradication has less success because of increasing clarithromycin resistance. Extended treatment and bismuth containing regimens were, therefore, investigated. PATIENTS AND METHODS: Consecutive H. pylori-positive patients with dyspepsia were randomly allocated to one of the three sequential regimens: The first group was given lansoprazole 30mg b.i.d. plus amoxicillin 1g b.i.d. for the first 5days, followed by lansoprazole 30mg b.i.d., clarithromycin 500mg b.i.d., and metronidazole 500mg t.i.d. for the second 5days (standard sequential, SS). The second group was given the same regimen but for 7+7days instead of 5+5days (extended sequential, ES). In the third group, colloidal bismuth 600mg b.i.d. was added to the second regimen for 14days (extended sequential+bismuth subcitrate, ES+B). Urea breath test or histology was performed before enrolment and 6weeks after the end of treatment to detect H. pylori. RESULTS: A total of 280 patients were included in the study. Per-protocol eradication rates were 62% (56/90), 72% (56/78), and 75% (54/72) in patients who received SS, ES, and ES+B regimens, respectively. Moreover, intention-to-treat eradication rates were 53% (56/104), 62% (56/90) and 62% (54/86), respectively. The differences in eradication rates between the groups were not statistically significant. CONCLUSION: Although prolonging of the sequential treatment to 14days may be considered, addition of bismuth to the regimen is of no avail.