NEW PATIENTS PRESENTING TO THEIR GP WITH DYSPEPSIA: DOES HELICOBACTER PYLORI ERADICATION MINIMISE THE COST OF MANAGING THESE PATIENTS?

Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.     

Octreotide, a somatostatin analogue, alters ovarian sensitivity to gonadotrophin stimulation as measured by the follicle stimulating hormone threshold in polycystic ovary syndrome

The aim of the present study was to determine the effect of octreotide, a somatostatin analogue, on ovarian sensitivity for follicle stimulating hormone (FSH) in patients with polycystic ovary syndrome (PCOS). As the measure of ovarian sensitivity, the FSH threshold was determined in a case-control set-up. Eleven patients with PCOS were treated with FSH in a low dose step-up manner and subsequently received treatment with FSH combined with octreotide. The FSH threshold was found to be significantly higher during combined treatment. This increase was associated with a decrease in insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) concentrations during treatment with octreotide, but not with a decrease in insulin concentrations. No differences were found between the two regimens, in number of follicles, in oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration or in ovulation rate. With both treatments, there was a very low rate of multifollicular development. It can be concluded that octreotide lowers ovarian sensitivity for FSH through suppression of IGF-I/IGFBP-3 in patients with PCOS. However, this does not appear to affect follicular development during gonadotrophin stimulation, because the latter is controlled to a high degree by the use of a low dose step-up treatment schedule in these patients.      

Unusual computed tomography appearances of acute cholangitis

This case describes some unusual computed tomography findings in a patient with an acute ascending cholangitis and pancreatitis due to a calculus impacted in the distal common bile duct.