Helicobacter pylori seropositivity and atherosclerosis risk factors

Certain viral and bacterial infections may contribute to the initiation and progression of atherosclerosis. The aim of this study is to determine whether Helicobacter pylori (HP) seropositivity contributes to conventional atherosclerosis risk factors in the development of an early sign of atherosclerosis: intima-media thickness (IMT) of the carotid artery. Eighty-four patients who had at least two conventional atherosclerosis risk factors and a control group of 50 patients having no risk factors for atherosclerosis were enrolled in the study. None of the patients had ever received HP eradication treatment. HP IgG antibodies were determined by enzyme-linked immunosorbent assay. Carotid artery IMT was measured 1 cm before the carotid bifurcation. Seventy-five percent of the study group was HP seropositive. HP seropositive (n=64) and seronegative (n=21) groups were identical in terms of sex distribution, smoking pattern, mean age, hemoglobin, leukocyte, platelet, C-reactive protein, erythrocyte sedimentation rate, glucose, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic blood pressure levels. There was no significant difference between the mean carotid IMT of HP seropositive (0.8+/-0.3 mm) and negative (0.8+/-0.3 mm) patients in the study group. Similar to the study group, there was no statistically significant difference between mean carotid IMT of HP seropositive (0.56+/-0.19 mm) and negative patients (0.67+/-0.13 mm) in the control group (p=0.2). Future studies concerning virulent strains are needed to determine the probable role of HP in atherosclerosis.     

Fragmentation without extraction in ureteral stones: outcomes of 238 cases

We aimed to evaluate the success rates, auxiliary procedures and complications after ureteroscopic lithotripsy (URS) during which the fragments left in situ for spontaneous passage after complete disintegration into a acceptable (<4 mm) size. 238 patients with ureteral stones were treated with URS between 2005 and 2011, and disintegrated fragments (<4 mm) were left in situ for spontaneous passage. Patients were followed with radiography for 3 months and evaluated with respect to the success rates (stone-free), auxiliary procedures, complication rates and additional analgesic requirement. The median age was 42.2 ± 13.7 years, and overall stone size was 8.79 ± 2.94 mm. Significantly lower rate of stone-free status was achieved in proximal stones (p < 0.05). A second URS was necessary in 5% (n = 12) of the patients. Double-J catheter placement during initial URS did not cause any change in the rate of secondary URS (p = 0.620). Additional oral or intramuscular analgesia was required in 41% (n = 97) and 25% (n = 59) of the patients, respectively, after discharge. The overall stone-free rate was 95% and mean time to complete clearance was 5 days. Severe colic pain within 24 h was noted in 21 (9%), and transient hydro-ureteronephrosis in 31 (13%) patients, as minor complications. Leaving the fragments (<4 mm) in place for spontaneous passage following a successful disintegration in URS could be a reasonable approach with acceptable and comparable stone-free rates, and this approach appears to give chance of shortening the duration of operation and also avoiding from the potential morbidity of repeated manipulations during the both further disintegration and extraction.     

The effect of citrate replacement in hypocitraturic cases on the results of SWL: a preliminary prospective randomized study

Purpose

To evaluate the possible effects of citrate replacement on the efficacy of shockwave lithotripsy (SWL) in the management of kidney stones in cases with hypocitraturia.

Methods

Forty hypocitraturic cases with renal pelvic stones were randomized into two groups; while citrate replacement has been done before and at the time of SWL in Study Group I (n: 20), SWL was performed without any additional specific management for hypocitraturia in Study Group II (n: 20). Twenty normocitraturic cases were also chosen as the control group (Group III). Data of the patients were evaluated comparatively.

Results

Patient, stone, and urinary pH characteristics of the groups were similar. Pre-SWL urinary citrate levels were 0.71 (0.1?C1.3), 0.86 (0.1?C1.4), and 3.12 (1.8?C4.4)?mmol/24?h in Group I, II, and III, respectively. Urinary citrate value increased from 0.71 (0.1?C1.3) to 1.96 (1.6?C4.1)?mmol/24?h following replacement therapy (before and at the time of SWL) in Group I. Mean number of SW (p?=?0.461), rate of stone-street formation (p?=?0.146), and Double-J placement (p?=?0.291) were similar in Group I and Group II. While the mean number of SWL sessions (2.27?±?0.71 in Group I vs. 2.94?±?0.59 in Group II; p?=?0.027), and time to stone-free status [29.1 (16?C47) days in Group I vs. 38.4(21?C63) days in Group II; p?=?0.043], was significantly different between study groups, these parameters were found similar between Group I and Group III.

Conclusions

In our study, the patients with hypocitraturia, who did receive replacement therapy, tended to require lower number of SWL sessions and became stone free in a shorter period than the others who underwent SWL without any specific management of hypocitraturia.     

Idiopathic Ventricular Arrhythmias Detected by an Implantable Loop Recorder in a Child with Exercise-Induced Syncope

Syncope is common in the general population. Despite extensive evaluation, including tilt-table testing and electrophysiologic studies, approximately 30% of cases of recurrent syncope remain unexplained. An implantable loop recorder can be used for diagnosis when recurrent syncope has an idiopathic cause. We present the case of a 9-year-old boy who had a history of recurrent, exercise-induced syncope. Results of physical examination and noninvasive diagnostic testing were inconclusive, and an electrophysiologic study revealed no inducible supraventricular or ventricular arrhythmias. Sixteen months after an implantable loop recorder was placed, the patient had a syncopal episode while swimming in a pool. Cardiopulmonary resuscitation was performed, and data from the loop recorder revealed polymorphic ventricular tachycardia and ventricular fibrillation. A cardioverter-defibrillator was subsequently implanted.Implantable loop recorders can play an important role in the diagnosis of life-threatening arrhythmias in children whose syncope is otherwise unexplained.Key words: Arrhythmias, cardiac/diagnosis; child; electrocardiography, ambulatory/instrumentation/methods; information storage & retrieval/methods; monitoring, physiologic/methods; prostheses and implants; syncope/diagnosis/etiology/therapySyncope, near-syncope, and palpitations are common in children. Although these events are typically benign, they can cause anxiety and concern. Young age and the presence of congenital cardiac problems or ion-channel abnormalities tend to increase the suspicion of severe heart disease. Other factors are syncope''s association with exertion or palpitations, or a family history of sudden cardiac death (SCD).^1–3 Determining the underlying cause is important when evaluating risks and selecting appropriate therapy; however, it can be difficult to pinpoint the cause of syncope in children.⁴ In many cases, physical examination and careful investigation of personal and family medical histories can suffice. The next diagnostic steps involve electrocardiography (ECG), echocardiography, Holter monitoring, stress testing, and sometimes tilt-table testing. Particularly in patients with structural heart disease, arrhythmia can lead to cardiac syncope and necessitate an invasive electrophysiologic (EP) study or catheter ablation.^3,4 Sometimes, however, neither of these can help to determine the mechanism of syncope.An implantable loop recorder (ILR) is a medical device that can monitor heart rhythm for a long time (up to 3 years) and record diagnostic information during syncopal episodes.^4–6 It is implanted in subcutaneous tissue, typically in the pectoral area. The ILR has proved to be effective in monitoring syncope in adults; however, there is less information on its use in children.^6,7 We present the case of a child who had recurrent exercise-induced syncopal episodes, and we describe the role of an ILR in the patient''s diagnosis and treatment.     

Relationships Between Serum Free Fatty Acids and Zinc, and Attention Deficit Hyperactivity Disorder: A Research Note

The purpose of this study is to evaluate the relationships between serum free fatty acids (FFA) and zinc, and attention deficit hyperactivity disorder (ADHD). Forty eight children with ADHD (33 boys, 15 girls) were included in the patient group and 45 healthy volunteer children (30 boys, 15 girls) constituted the control group. The mean serum FFA level in the patient group was 0.176 ± 0.102 mEq/L and in control group, 0.562 ± 0.225 mEq/L ( p < .001). The mean serum zinc level of patient group was 60.6 ± 9.9 μg/dl and that of the control group. 105.8±13.2 μg/dl (p < .001). A statistically significant correlation was found between zinc and FFA levels in the ADHD group. These findings indicate that zinc deficiency may play a role in aetiopathogenesis of ADHD. Although we observed decreased FFA levels in ADHD cases, it is necessary to determine whether this condition is a principal cause of ADHD or is secondary to zinc deficiency.