Triple regimens using lansoprazole or ranitidine bismuth citrate for Helicobacter pylori eradication.

BACKGROUND: A combination of an antisecretory agent with two antibiotics is considered the 'gold standard' for Helicobacter pylori eradication. OBJECTIVES: To compare the eradication rates and the safety profile of two short-term triple therapies containing lansoprazole (L) or ranitidine bismuth citrate (RBC) as antisecretory agents. METHODS: One hundred and twelve H. pylori-positive patients either with peptic ulcer (56 duodenal ulcers: 25 active and 31 with a history of ulcer; 13 gastric ulcers: nine active and four with a history of ulcer) or gastritis (43) were included in an open, randomized, controlled trial. H. pylori infection was initially detected by CLO-test and histology on antral and corpus biopsies. H. pylori-positive patients were randomized to receive L plus clarithromycin (C) 250 mg b.d. plus tinidazole (T) 500 mg b.d. (LCT) or RBC plus C 250 mg b.d. and T 500 mg b.d. for 7 days (RbcCT). L or RBC were administered for a further 3 weeks in patients with active peptic ulcers. A second endoscopy was performed at least 6 weeks after the end of therapy for the assessment of H. pylori infection by CLO-test and histology. Eradication was assumed if all the tests were negative for H. pylori. RESULTS: Forty-eight patients in the LCT group and 4 5 in the RbcCT group were assessed for H. pylori eradication. The eradication rates, according to intention-to-treat (ITT) and per protocol (PP) analyses were, respectively, 76.8% and 89.5% for the LCT group, and 73.2% and 91.1% for the RbcCT group. No statistically significant difference in eradication rates was found between the two groups by Mantel-Haenszel test. All peptic ulcers were healed. In patients in whom H. pylori had been eradicated, the severity of gastritis was significantly reduced. Side-effects were rare. One patient in the LCT group and two in the RbcCT group were withdrawn because of adverse events. CONCLUSION: Short-term triple therapy with either lansoprazole or RBC is equally effective and well tolerated.

Omeprazole versus ranitidine: short-term triple-therapy in patients with Helicobacter pylori-positive duodenal ulcers.

AIM: To compare the results of two short triple-therapy regimens, different only in the antisecretory drugs used, in patients with active duodenal ulcer and Helicobacter pylori infection. METHODS: All patients received a combination of clarithromycin 250 mg b.d. and tinidazole 500 mg b.d. for 1 week, in addition to an antisecretory drug: omeprazole 20 mg (50 patients) or ranitidine 300 mg (50 patients) twice daily for 1 week, followed by a single daily dose for a further 3 weeks. Upper gastrointestinal endoscopy, with rapid urease test and histological examination of antral and corpus biopsies, was performed prior to the treatment and at least 2 months after the discontinuation of the antisecretory therapy. RESULTS: Duodenal ulcer healing was documented in all patients at the endoscopic examination after therapy. H. pylori eradication was achieved in 46 of 50 patients (92%, 95% CI = 85-99%) in the omeprazole group and in 43 of 50 patients (86%, 95% CI = 76-96%) in the ranitidine group: the difference is not significant. CONCLUSION: Omeprazole or ranitidine, in combination with clarithromycin and tinidazole, are equally effective in the eradication of H. pylori infection and healing of duodenal ulcers.

[Malignant Brenner's tumor of the ovary: description of a case]. / Tumore di Brenner maligno dell'ovaio: descrizione di un caso.

A case of malignant Brenner tumor (MBT) in a 42-year-old woman is described. According to the literature it is evident how rare this type of MBT is as well as the histogenetic problems arising in this neoplasia deriving from the coelomic epithelium. The malignant histologic criteria are those adopted in 1973 by Hull and Combell who showed as unquestionable signs the association of benign and malignant Brenner tumor, the invasion of the stroma on behalf of the malignant Brenner elements and the absence of mucinous cystadenoma or the association with the above mentioned.

[Hazards of thrombolysis. A clinical case]. / I pericoli della trombolisi. Caso clinico.

Thrombolytic therapy has led to a reduction in early and late mortality in myocardial infarction but it is not without its dangers. Two cases are reported in which it was adopted inadvisedly considering that later pathologies other than acute myocardial infarction were demonstrated. A less aggressive attitude is advised for emergency thrombolysis (pending the arrival of more effective, safer drugs) in the more peripheral centres where possible complications may be more difficult to handle.

[A case of fetal sacro-coccygeal teratoma]. / Un caso di teratoma sacro-coccigeo fetale.

Here is described a case of sacro-coccygeal teratoma observed in a 26th week still-born fetus characterized by differentiating aspects of the three embryonal layers with immature features of the ectodermal and mesodermal derivatives but not those of the entoderm. On the base of the findings observed, the classifying approach of these neoplasms has been reconsidered.