δ13CO2 Excretion and Expression of Dyspeptic Symptoms in Patients Evaluated for Helicobacter pylori Infection by [13C] Urea Breath Test

Previous studies showed that either the urease activity possessed by H. pylori and the bacterial load may influence the results of the [¹³C] urea breath test. However, the correlation between urease activity and dyspepsia is unclear. The aim of our study was to evaluate whether the urease activity of the gastroduodenal tract may influence the severity of dyspeptic symptoms. In all, 2520 dyspeptic patients (1109 men, 1411 women; mean age 47 ± 16 years) without gastroesophageal reflux disease, diabetes, vascular disorders, liver and biliary tract diseases, and tumors of the gastrointestinal tract and with a normal appearing abdominal ultrasonography were enrolled. All these patients underwent a [¹³C] urea breath test and filled out a questionnaire on dyspeptic symptoms. Subjects were divided in five different groups according to delta over baseline (DOB) values (group 1 < 3.5, group 2 = 3.5–6; group 3 = 6.1–11, group 4 = 11.1–23, group 5 > 23.1). The prevalence and intensity of dyspeptic symptoms were compared among groups. In all, 1688 patients (67%, 928 females and 760 males; mean age 48 ± 15 years) were H. pylori-positive. The chi-squared test and analysis of variance showed increase of frequency and intensity of each dyspeptic symptom according to DOB values. In conclusion, Dyspepsia may parallel gastric urease activity. However, whether higher DOB values are related to higher bacterial load or, alternatively, to the presence of particular H. pylori strains able to produce larger amounts of urease is uncertain.     

Sentinel lymph node mapping and biopsy for malignant melanoma at a rural-based university medical center

Sentinel lymph node mapping and biopsy (SLNMB) is a standard of practice in the management of cutaneous malignant melanoma (CMM). Since there were no published articles reviewing the experience of a single-institution, rural-based university medial center, we compiled our results from the patients we treated from Nov. 11, 1998 to May 23, 2001. A total of 54 caucasian patients (35 males, 19 females) of a median age of 60 years (range 2-84) were surgically treated, including 29 cases on the extremities, 16 trunk cases, and nine of the head/neck. Median Breslow thickness was 1.50 mm (range 0.23-12.0). Median Clark's level was 4 (range 2-5). Forty-seven patients underwent sentinel lymph node (SLN) injection and preoperative lymphoscintigraphy. Preoperative lymphoscintigraphy revealed radiocolloid uptake in 53 regional lymph node basins (RLNB), including two separate RLNB in four patients and three separate RLNB in one patient. Intraoperatively, SLN localization of radiocolloid was shown in 53 RLNB and SLN localization of blue dye was demonstrated in 38 RLNB. SLNs were positive in six of 52 (11.5%) RLNB biopsied and six of 46 (13.0%) patients. Our initial experience with SLNMB was encouraging and holds promise for rural-based practices by sparing added morbidity and inconvenience of more extensive surgery.     

角膜内植入物并发基质内上皮混浊

目的：报告应用角膜内植入物矫正远视眼后发生角膜周边部上皮性混浊的新的并发症。设计：前瞻性观察研究。参加者：7例患者的11只眼行角膜内植入矫正远视。方法：应用显微角膜板层刀制作一个蒂在下方的角膜瓣，将角膜内移植物植入角膜基质床中。     

Scar pregnancy: a rare complication of caesarean section

In this paper, we report a rare type of ectopic pregnancy implanted in a previous caesarean scar. Scar pregnancy was diagnosed at six weeks gestation in a woman with three prior caesarean deliveries. Management with the usual dose of Methotrexate was unsuccessful. The patient continued to have pelvic pain, the beta human chorionic gonadotropin (ßhCG) increased and there was persistent foetal cardiac activity. Subsequently, dilatation and curettage was performed under ultrasound guidance without complications. We conclude that scar pregnancy presents a diagnostic and therapeutic challenge to the clinician and the optimal management strategy needs to be explored.