HELICOBACTER INFECTION IN CHILDREN WITH APPENDICITIS AND LACTOSE INTOLERANCE

Helicobacter pylori eradication has been debated. Most investigators do not recommended treating the infection except in severe case. We report a unique case: H. pylori infection with appendicitis and lactose intolerance.  

Case report:

A 6 year old girl was brought to children and maternity Hospital Harapan Kita due to abdominal pain and vomiting. She had 6- month history of epigastric pain. In the past 2 days, she suffered from abdominal pain arround Mc. Burney area. On physical examination, she was in pain. Her weight was 19 Kg. Vital signs were normal. Findings in heart, lung and extremities were also normal.  

Abdomen:

severe pain in the epigastric and Mc. burney area.Laboratory investigations showed hemoglobin 12 g/dl, leukocyte 12800/ul. Platelets 289000/ul. Bleeding and clotting time were normal. Abdominal ultrasonography revealed inflammation of appendix with 9-mm diameter. Stool examination was normal.Appendectomy was done at the same time with esofagogastroduodenoscopy (EGD). On EGD, we found moderete anthral gastritis. On histopathological examination, we found H. pylori at antral of the stomach. Breath hydrogen test was positive.After H. pylori eradication and milk avoidance, abdominal pain has never occurred.  

Conclusion:

Abdominal: pain is not specific for H. pylori infection. The pain caused by many diseases including H. pylori infection. In our case, we can control abdominal pain by H. pylori eradication.     

Treatment of migraine and tension-type headache in Croatia

The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.     

The effects of mandatory health insurance on equity in access to outpatient care in Indonesia

This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.     

Autopsy-determined causes of death in solid organ transplant recipients

The aim of this study was to review the main causes of death as determined by autopsy of deceased solid organ transplant recipients. We reviewed 156 autopsies including 76 heart, 32 liver, 29 kidney, and 19 lung transplant recipients. The mean survival period varied depending on the transplanted organ: namely heart, 497 days; liver, 189 days; kidney, 1124 days; and lung, 252 days. Infections were the most common cause of death in all groups, varying from 21% in heart to 63% in lung recipients. Acute rejection, chronic rejection, and malignancies only appeared as the cause of death in heart recipients (14.5%, 9.2%, and 4%, respectively). Primary graft failure was present in heart (15.7%), kidney (3.4%), and lung (5.3%) recipients. The highest rate of surgical complications as a cause of death was observed in heart transplant recipients. In all groups there was a significant percentage (about 30%) of other pathologies that were responsible for death, such as pulmonary embolism, central nervous system pathology, acute pancreatitis, digestive hemorrhage, and acute myocardial infarction. Our results emphasize that infections are the main cause of death within the first year posttransplant, independent of the organ transplanted.     

Tuberculous peritonitis. Report of 2 cases

They are revised the clinical and diagnostic manifestations of tuberculous peritonitis. For this, it is provided our experience in three cases: 2 women and 1 man with ages between 49 and 79 years old. The more frequent clinical manifestations were general syndrome and ascites in all the cases (100%) and fever in 2 (66%). The mantoux was positive in two cases. The peritoneal fluid presented lymphocytic exudate and determination of adenosine deaminase increased in all the cases. The diagnosis was performed through laparoscopy with peritoneal biopsy with presence of necrotic granulomas. Only in 1 case,is identified growth of Mycobacterium tuberculosis in peritoneal fluid. All the patients answered positively to the specific treatment.     

Acquired inv(9): what is its significance?

Pericentric inversion of the heterochromatic region of chromosome 9 [inv(9)] is a common heteromorphism in the general population. It is presumed familial as there are no reports of de novo inv(9) chromosomes in constitutional karyotypes. We report 2 cases of acquired inv(9) chromosomes; 1 patient with acute myeloid leukemia, 46,XY,inv(9)(p11q13)[11]/46,XY[9], and a second with severe anemia, 46,XX,inv(9)(p11q13)[14]/46,XX[6]. The acquired nature of the inv(9) was confirmed by constitutional karyotyping and/or molecular analysis. The inv(9) in these patients may be a de novo inversion that cytogenetically mimics the constitutional inv(9) heteromorphism. Alternatively, it may be the result of neocentromere activation in 9q due to epigenetic events associated with the disease in these patients that results in a metacentric chromosome similarly mimicking the constitutional inv(9). One previous report of an acquired inv(9) was in a patient with essential thrombocythemia. The differences in clinical presentation may represent different underlying mechanisms generating the inv(9). The significance of an acquired inv(9) is unknown and will require reporting of additional cases.     

Assessment of 3-dimensional computer-generated cephalometric measurements.

The purpose of this study was to assess the reliability of 3-dimensional computer-generated linear and angular measurements produced by different computer algorithms and various combinations of cephalogram projections compared with direct and CT measurements. A computer program was written to provide 4 computer algorithms and 4 combinations of cephalogram projections generating 22 linear and 10 angular 3-dimensional measurements from 20 landmarks. A new technique to produce biplanar cephalograms from a single x-ray source using a special facebow was developed, and its reliability was assessed. Sets of lateral, frontal, and basilar cephalograms of a human dried skull were taken both with 20 radiopaque landmark markers and without markers. Paired t tests based on marker position demonstrated reliability of the facebow; there were no statistically significant differences in repositioning the skull over time using the facebow at P <.05. In the ideal situation, with minimal head rotation and landmark identification error (with the facebow and radiopaque markers), the average error of linear measurements was 1. 5 mm and 3.5(o) for the angular measurements. Subsequent trials evaluated the errors in head position (within 5(o) of head rotation) and in landmark identification (by removing all markers); two-way ANOVA with Scheffé groupings concluded that the vector intercept with manual adjustment algorithm using the lateral-frontal biplanar projection provides not only greater accuracy but also clinical practicality for both linear (mean of 2.2 mm error) and angular (mean of 4.0(o) error) measurements compared with direct or CT measurements (P <.05). The effect of landmark identification error was found to be slightly greater than the head rotation error in the accuracy of 3-dimensional linear and angular measurements (mean, 2.85 mm error for linear and 4.4(o) error for angular measurements). Lastly, this study concluded that linear measurements in the transverse direction were found to have a slightly larger error than vertical measurements. Anteroposterior measurements have the least error.     

A new accurate approach to the anterior ratio with clinical applications. Part 1: a computer program.

The arcs of the six anterior maxillary and mandibular teeth have recently been described mathematically by the hyperbolic cosine function with a maxillary correlation coefficient (r ) of 0.885 and a mandibular correlation coefficient (r ) of 0.951. Because the geometric relationships of the anterior dental arcs are known when the occlusion is Class I, a computer program has been developed for use in clinical practice. Rapid forecasting of the interrelationships between the maxillary and mandibular arc depths (related to overjet) with variations in the mesiodistal sums of the six maxillary and mandibular anterior teeth for various intercanine widths is now possible with ease and accuracy (+/- 0.1 mm). Clinical applications are illustrated.     

Incidence of the superficial fascia and its relevance in skin-sparing mastectomy

BACKGROUND: With the move away from classical radical mastectomy to ever more skin-sparing procedures, there has been an ongoing discussion about how much skin and subcutaneous tissue should be resected to perform an adequate mastectomy while leaving viable skin flaps. One of the common recommendations is to dissect just superficial to the superficial layer (SL) of the superficial fascia of the breast. This, in turn, has revived the old, unsolved controversy about the existence or absence of the SL, a fascia that reportedly encloses the mammary gland ventrally. In skin-sparing mastectomies (SSM), which combine tumor resection with immediate breast reconstruction, the ideal would be to create skin flaps that are thin enough to remove all breast tissue but at the same time are thick enough to preserve flap circulation. The feasibility of meeting these two goals simultaneously and the possible role and relevance of the SL as a guide to dissection in SSM was examined in this study. METHODS: Sixty-two breast resection specimens from 31 women who underwent breast reduction were examined histologically to determine whether the SL was present, whether breast tissue could be detected within or beyond this SL, the measured distance between the caudal border of the dermis and the SL or the breast tissue, and whether the thickness of the subcutaneous fat layer was correlated with the patients' physical data, such as body weight or body mass index (BMI). RESULTS: The SL was absent in 44% of resection specimens. When the SL was present, 42% of specimens contained several islands of breast tissue within the SL. No breast tissue was found beyond the SL. The minimal distance between the SL and the dermis varied from 0.2 mm to 4.0 mm; the minimal distance between the breast tissue and the dermis was 0.4 mm. In 50% of specimens, the minimal distance between the dermis and the SL or breast tissue was < 1.1 mm. A distance of > or = 5 mm was encountered in only 17% of specimens, and a distance of > or = 10 mm was encountered in only 5% of specimens. No significant correlation between the right and left breast was found with any of the parameters examined. A weak negative correlation was seen between the BMI and the mean thickness of the subcutaneous fat (P = 0.049; correlation coefficient [r] = -0.39; Spearman rank correlation). CONCLUSIONS: Histologic evaluation revealed that the SL is not present in all breasts and, thus, cannot serve as a reliable plane of dissection. Furthermore, if the SL is present microscopically, then it often is too thin and delicate to be detectable macroscopically. Finally, even if the SL is present and visible macroscopically, the distance to the overlying skin is so small in the majority of patients that a dissection superficial to the SL would not leave viable skin flaps in skin-sparing mastectomies.