Effectiveness of two quadruple, tetracycline- or clarithromycin-containing, second-line, Helicobacter pylori eradication therapies

BACKGROUND: There are no guidelines on second-line therapies for Helicobacter pylori eradication failures of omeprazole-clarithromycin-amoxicillin triple therapy. AIM: To compare the efficacy of two second-line therapies for persistent H. pylori infection. METHODS: Over a 6-year period, patients with persistent H. pylori infection following omeprazole-clarithromycin-amoxicillin eradication therapy were randomized to receive omeprazole, 20 mg twice daily, bismuth, 120 mg four times daily, metronidazole, 500 mg twice daily, and either tetracycline, 500 mg four times daily, or clarithromycin, 500 mg twice daily, given for 7 days. Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori infection was confirmed by histology. RESULTS: Of the 95 randomized patients, 88 (93%) completed the study. Age, sex, smoking, ulcer/non-ulcer dyspepsia ratio and antibiotic resistance were not significantly different between the treatment groups. On intention-to-treat analysis, eradication was achieved in 41 of the 49 patients (84%; 95% confidence interval, 70.4-92.7%) and 27 of the 46 patients (59%; 95% confidence interval, 43.3-73.0%) of the tetracycline- and clarithromycin-containing groups, respectively (P=0.007). On multivariate regression analysis, the sensitivity of H. pylori to metronidazole had a likelihood ratio of 5.2 (P=0.022), followed by the type of quadruple therapy (likelihood ratio, 4.4; P=0.036). CONCLUSIONS: Tetracycline-containing quadruple rescue therapy is highly effective in treating H. pylori eradication failures of the omeprazole-amoxicillin-clarithromycin regimen.     

Benign neurogenic tumors of the oral cavity

Neurogenic tumors are rare in the oral cavity, particularly so when malignant. Traumatic neuroma, although usually included with neurogenic tumors, is a reactive process rather than a true neoplasm. Neurofibroma and schwannoma derive from nerve fibers, the perineurium, the endoneurium and the neurolemmomal cells. They present histological differences. The neurofibroma may present in solitary and generalized types; the latter also known as neurofibromatosis or von Recklinghausen's disease of the skin. We here report typical cases of benign neurogenic tumors of the oral cavity.     

Nonstationary noise estimation in functional MRI

An important issue in functional MRI analysis is accurate characterisation of the noise processes present in the data. Whilst conventional fMRI noise representations often assume stationarity (or time-invariance) in the noise generating sources, such approaches may serve to suppress important dynamic information about brain function. As an alternative to these fixed temporal assumptions, we present in this paper two time-varying procedures for examining nonstationary noise structure in fMRI data. In the first procedure, we approximate nonstationary behaviour by means of a collection of simple but numerous time-varying parametric models. This is accomplished through the derivation of a locally parametric AutoRegressive (AR) plus drift model which tracks temporal covariance by allowing the model parameters to evolve over time. Before exploring time variation in these parameters, window-widths (bandwidths) that are well suited to the latent time-varying noise structure must be determined. To do this, we employ a bandwidth selection mechanism based on Stein's Unbiased Risk Estimator (SURE) criterion. In the second procedure, we describe the fMRI noise using a nonparametric method based on Functional Data Analysis (FDA). This process generates well-conditioned nonstationary covariance estimates that reflect temporal continuity in the underlying data structure whilst penalizing effective model dimension. We demonstrate both methods on simulated data and investigate the presence of nonstationary noise in resting fMRI data using the whitening capabilities of the locally parametric procedure. We evaluate the comparative behaviour of the stationary and nonstationary AR-based methods on data acquired at 1.5, 3 and 7 T magnetic field strengths and show that incorporation of time variation in the AR parameters leads to an overall decrease in the level of residual structure in the data. The FDA noise modelling technique is formulated within an activation mapping procedure and compared to the SPM (Statistical Parametric Mapping) toolbox on a cognitive face recognition task. Both the SPM and FDA methods show good sensitivity on this task, but we find that inclusion of the nonstationary FDA noise model seems to improve detection power in important task-related medial temporal regions.     

Spontaneous coronary dissection as a cause of acute coronary syndrome: evidence for non-inflammatory underlying mechanisms

An unusual case of giant hydatic cyst of the left ventricle producing cardiac and systemic symptomatology is described. The patient had suffered presyncopal and syncopal attacks and the final diagnosis was made by combination of echocardiography, magnetic resonance imaging and serological tests. Surgical resection of the cyst supplemented by medical therapy yielded favorable results.     

Validity and Reliability of the Greek Version of the Multiple Sclerosis International Quality-of-Life Questionnaire

Background and Purpose

There are no data regarding psychometrically validated, health-related quality-of-life instruments designed specifically for patients with multiple sclerosis (MS) in Greece. Recently, the MS International Quality-of-Life questionnaire (MusiQoL), a multidimensional, self-administered questionnaire, which is available in 14 languages (including Greek), has been validated using a large international sample. We investigated the validity and reliability of the Greek version of the MusiQoL.

Methods

Consecutive patients with different types and severities of MS were recruited from two tertiary-care centers in Greece. All patients completed the MusiQoL, the Short-Form-36 quality-of-life questionnaire (SF-36), and a symptom checklist at baseline and 21±7 days (mean±SD) later. Data regarding sociodemographic status, MS history, and functional outcome were also collected prospectively. Construct validity, internal consistency, reproducibility, and external consistency were tested.

Results

A total of 92 patients was evaluated. The construct validity was confirmed in terms of satisfactory item-internal consistency correlations and scaling success (87.5-100%) of item-discriminant validity. The dimensions of the MusiQoL exhibited high internal consistency (Cronbach''s alpha: 0.63-0.96), and reproducibility was satisfactory (intraclass correlation coefficients: 0.69-0.99). External validity testing indicated that the MusiQoL correlated significantly with all SF-36 dimension scores (Spearman''s correlation: 0.43-0.76).

Conclusions

The Greek version of the MusiQoL appears to be a valid and reliable instrument for measuring quality of life in Greek MS patients.     

A normative study of the trail making test A and B in Greek adults

The purpose of this study was to explore the effects of age and education on the performance of the Trail Making Test (TMT), and to provide normative data in the Greek population. The TMT was administered to 643 healthy participants. All participants satisfied the criteria excluding dementia and other medical, psychiatric, and neurological disorders. Statistical analysis revealed that, age, education, and general level of intelligence significantly influence individual performance. Performance on TMT, especially part B, decreases with increasing age and lower levels of education. Current norms of the Greek version of TMT represent a useful set of norms for clinical practice.     

Management of ingested foreign bodies. How justifiable is a waiting policy?

Foreign body ingestion is a commonly seen accident in emergencies, usually in children (80%), elderly, mentally impaired, or alcoholic individuals, whereas it may occur intentionally in prisoners or psychiatric patients. According to the literature, 90% of ingested foreign bodies pass through the gastrointestinal tract without complications, 10% to 20% necessitate endoscopic removal, whereas only 1% of them will finally need surgical intervention. In clinical practice, we often face the dilemma of choosing the appropriate treatment modality. We present 13 cases treated in our department, emphasizing in a "waiting and close observation" policy. Among these cases, only 1 patient needed to be operated because of obstruction of ileocecal valve by a large coin. Indications for treatment where applicable are also being discussed.     

Hemispheric predominance of abnormal findings in electroencephalogram (EEG).

The EEGs of 13,560 patients have been reviewed in order to determine whether abnormal findings, epileptiform or not, have a hemispheric dominance. We have included outpatients and hospitalized patients as well. Eight hundred and thirty-five EEGs had generalized abnormal findings, and 414 EEGs had lateralized abnormal findings. The EEGs of 322 patients (77.7%) had a left predominance, and those of 92 patients (22.3%) had a right predominance, of abnormal findings. A strong left predominance has been noted for the epileptiform discharges, i.e. 128 (79%) vs. 34 (21%). These results raise the possibility that the left hemisphere may be more vulnerable to nosological processes.