Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia.

Hypertriglyceridemia causes acute pancreatitis in 1.3-3.8% of patients. We report here on two cases with severe (triglyceride level >1000 mg/dL) hypertriglyceridemia-induced acute recurrent pancreatitis. Both patients had uncontrolled hypertriglyceridemia and suffered from acute pancreatitis. No cause of secondary hypertriglyceridemia was detected. While stage E pancreatitis (Ranson's score: 2) was diagnosed in the first case, stage D pancreatitis with a null Ranson's score was detected in the second case. Both patients were treated with classical treatment with fluid replacement, analgesic, antibiotics and discontinuation of oral intake. Therapeutic plasma exchange (TPE) with fresh frozen plasma was performed consecutively and with two procedures on the 2nd and 3rd day in the first case. After TPE, while the triglyceride levels decreased from 4408 to 302 mg/dL, the amylase levels dropped from 4234 to 171 IU/L. In the second case, TPE was performed once daily. After TPE, the levels of triglyceride and amylase decreased from 2210 mg/dL and 1618 IU/L to 154 mg/dL and 110 IU/L, respectively. Local and systemic complications due to acute pancreatitis were not observed. Clinical signs and laboratory values improved. At the two-year follow-up of both patients, acute pancreatitis had not recurred with regular fenofibrate treatment. Hypertriglyceridemia should be considered in patients with acute recurrent pancreatitis. Although there is no definitive evidence for early application of TPE in severe hypertriglyceridemia-induced acute pancreatitis yet, therapy with TPE may be of benefit, improving the clinical course.

In treatment of active duodenal ulcer and Helicobacter pylori eradication.

AIM: To compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcer and Helicobacterpylori eradication. METHODOLOGY: A total of 50 patients, with a positive rapid urease test and endoscopically diagnosed active duodenal ulcer, were randomly assigned to one of two treatment groups after endoscopic examinations. Patients in the first group received lansoprazole 30 mg b.d., amoxycillin 1000mg b.d., clarithromycin 500 mg b.d.; patients in the second group received pantoprazole 40 mg b.d., amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d for two weeks. Patients were scheduled for repeat endoscopic examination; repeat rapid urease test, and histological examination 4 weeks after the end of the therapy. RESULTS: Hp was eradicated in 84.2% of the patients received lansoprazole and in 83.3% of the patients received pantoprazole. The difference was not significant (P>0.05). In the lansoprazole group 90.5%, and in the pantoprazole group 83.3% of the patients experienced complete duodenal ulcer healing at the time of follow-up endoscopic examination. We found no statistical significant difference between the two groups. CONCLUSION: Lansoprazole and pantoprazole both have similar effect in eradication of Hp, and in terms of ulcer healing. Comparative studies in larger trials are needed to compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcers.

Lacrimal gland marginal zone lymphoma: regression after treatment of chronic hepatitis C virus infection: case report and review of the literature.

A 43-year-old woman was first admitted to the ophthalmology clinic with the complaint of a mass compressing the right eye. Based on clinical and laboratory examinations she was diagnosed as having marginal zone lymphoma (MZL) of the right lacrimal gland in addition to hepatitis C virus (HCV) infection. After the treatment for HCV infection with pegylated interferon plus ribavirin, a radiographic response of the MZL was obtained; she remains in remission through thirty months of clinical follow-up. In this case, the treatment of HCV infection led to regression of MZL suggesting the necessity of testing for HCV infection and treatment of the HCV infection should be highly considered in all HCV-positive patients with MZL's.