Background and aim: Helicobacter pylori (H.pylori) infection can cause chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma.For this reason, eradication of H. pylori has become an important issue.In recent years, failure of eradication therapy with standard eradication regimes had directed toward new therapeutic alternatives.The present study aimed to show the efficacy of bismuth-containing quadruple regimen for the first-line treatment of H. pylori infection.Materials and methods: H. pylori positive patients received a quadruple therapy consisted of esomeprazole 20 mg bid, colloidal bismuth subcitrate 600 mg bid, tetracycline 500 mg qid and metronidazole 500 mg tid for 7 days.The diagnosis of H. pylori infection was performed by the histopathological assessment of gastric biopsies.Six weeks after completion of therapy, H. pylori status was rechecked by C14 urea-breath test.Results: A total of 115 patients have completed the protocols (upper gastrointestinal endoscopy, treatment, urea-breath test).H. pylori eradication rate was found to be 87%.This eradication rate is significantly higher than those of classic triple therapies in the literature. Conclusion:The bismuth-containing quadruple regimen achieved an acceptable and very higher eradication rate than those of classic triple therapies in the literature.It can recommend as a first-line therapy for Helicobacter pylori infection.

Objectives: Previous studies have suggested that CagA positive Helicobacter pylori (H.pylori) infection may cause the various oxidative damages. The objective of this study was to investigate serum oxidative status in infectetion with CagA positive H.pylori strains. Materials and methods: Forty-two H.pylori CagA positive subjects and 39 H.pylori CagA negative subjects were enrolled. H.pylori infection was diagnosed by the histopathological assessment of gastric mucosa. CagA status was detected by enzyme immuno assay in a micro ELISA machine. Total antioxidant status (TAS) and total oxidant status (TOS) were measured autoanalyzer using commercially available kits. Serum oxidative stress index (OSI) was calculated using TAS and TOS measurements. Results: The levels TAS and TOS of CagA positive subjects were found to be 1.48 ± 0.18 mmol/L, 36.88 ± 19.84 mmol/L. Those of CagA negative group were measured to be 1.43 ± 0.19 mmol/L and 38.44 ± 14.72 mmol/L respectively. The values of serum OSI were similar (25.28 ± 15.85 and 26.48 ± 10.02) in CagA positive and negative groups. Conclusions: The measurements of serum oxidative status did not show any sigficant difference between the patients infected with CagA positive and CagA negative H.pilori strains. J Clin Exp Invest 2011;2(2):202-6

Objectives: The malign lesions of stomach may be ulcerative. Today, the follow-up periods for patients with gastric ulcer (GU) has not been clearly defined. The aim of this study was to assess the significance of ulcer size and location in differential diagnosis of GUs at endoscopy. Materials and methods: Data were retrospectively collected from the records of gastrointestinal endoscopy unit and pathology laboratory of our hospital between August 2008 and October 2010. We evaluated the demographic, endoscopic and histopathological features of the patients with GU. ROC curve analysis was performed for determining cut-off diameter differing malign ulcer from benign ulcer during gastroscopy. Results: A total of 161 patients (81 males, 80 females) with gastric ulcer were included. Twenty-seven patients had malign ulcer and 134 had benign ulcer. Mean ages of groups of malign and benign ulcer were 66.4 ± 13.8 and 56.7 ± 17 years, respectively (p<0.05). Ulcer locations were angulus and antrum in 48% of the patients with malign ulcer and in 86% of with benign ulcer. Mean ulcer diameters were 21.1 ± 12.4 mm and 8.3 ± 6.2 mm, for malign and benign ulcers respectively (p<0.05). Cut-off diameter of gastric ulcers for differing malign from benign was 11 mm. Sensitivity and specifity of this value was 88.9% and 88.8%, respectively. Conclusions: Although, the site of the ulcer cannot be taken as indicative of its nature, ulcer size may help for predicting ulcer nature. Malignant ulcers tended to be larger (≥11 mm). The repetition of endoscopy may be delayed until the end of treatment in small ulcers (<11 cm).

Objectives: Helicobacter pylori (H.pylori) infection is major etiologic factor of chronic active gastritis and peptic ulcer disease. Functional dyspepsia (FD) is defined as “persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patient who has no definite structural or biochemical explanation of their symptoms. It is uncertain whether treatment of H.pylori infection relieves symptoms in patients with FD. We searched short term effects of H.pylori eradication for symptoms in patients with FD.Material and method: We enrolled patients with dyspeptic symptoms which were diagnosed FD and satisfied en-rollment criteria of trial. Endoscopic biopsy was taken from each patient during upper gastrointestinal endoscopy. H.pylori infected patients were assigned to seven days of treatment with 30 mgr of lansoprozole twice daily, 1000 mg of amoksisilin twice daily, and 500 mg levofloxacin once daily. Patients were assessed whether treatment was suc-cessful or not by 14C urea breathe test after 6-8 week. Also pretreatment and post treatment symptom scores were questioned.Results: There were 99 female and 68 male patients. After treatment 114 patients (68%) was negative for H. pylori, 53 patients (32%) remained positive. Mean of age and proportion of sex was similar in H.pylori (+) and (-) groups. While 111 (97.4%) of H.pylori (-) patients’ symptom scores decreased, 38 (71.7%) of H.pylori (+) patients’ scores de-creased. There was significant differences between two groups (p=0.001).Conclusion: Eradication of H.pylori relieves the symptoms of functional dyspepsia. New trials for long term effect of H.pylori eradication on symptoms must be conducted in future.

Objectives: Helicobacter pylori ( H.pylori) infection is major etiologic factor of chronic active gastritis and peptic ulcer disease. Functional dyspepsia (FD) is defi ned as “persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patient who has no defi nite structural or biochemical explanation of their symptoms. It is uncertain whether treatment of H.pylori infection relieves symptoms in patients with FD. We searched short term effects of H.pylori eradication for symptoms in patients with FD. Material and method: We enrolled patients with dyspeptic symptoms which were diagnosed FD and satisfi ed enrollment criteria of trial. Endoscopic biopsy was taken from each patient during upper gastrointestinal endoscopy. H.pylori infected patients were assigned to seven days of treatment with 30 mgr of lansoprozole twice daily, 1000 mg of amoksisilin twice daily, and 500 mg levofl oxacin once daily. Patients were assessed whether treatment was successful or not by 14C urea breathe test after 6-8 week. Also pretreatment and post treatment symptom scores were questioned. Results: There were 99 female and 68 male patients. After treatment 114 patients (68%) was negative for H. pylori, 53 patients (32%) remained positive. Mean of age and proportion of sex was similar in H.pylori (+) and (-) groups. While 111 (97.4%) of H.pylori (-) patients’ symptom scores decreased, 38 (71.7%) of H.pylori (+) patients’ scores decreased. There was signifi cant differences between two groups (p=0.001). Conclusion: Eradication of H.pylori relieves the symptoms of functional dyspepsia. New trials for long term effect of H.pylori eradication on symptoms must be conducted in future.

The most common site for gastrointestinal involvement in tuberculosis is the ileocecal region. Tuberculosis of stomach is quite uncommon. It is usually associated with pulmonary tuberculosis or with immunodeficiency. In this case non specific gastrointestinal complaints yielded a diagnosis of primary gastric tuberculosis, which is very rare. Absence of pulmonary focus and endoscopic findings of pangastritis are different features of this case which makes it presentable.

Opportunistic fungal infections are usually seen in immunocompromised patients. While Candida is the most prevalent agent in such infections, Aspergillus is at the second order. Primary cutaneous aspergillosis is most common in immunocompromised patients but can rarely be seen in healthy hosts as well. We report a case of posttraumatic primary cutaneous aspergillosis and Candida guilliermondii coinfection in a 70-years-old healthy man. The patient had an ulcerous lesion which developed in the site of a trauma on the middle finger of the right hand. Histopathological examination of the biopsy specimens revealed septate hyphae with dichotomous branching small circular blastospores. The cultures of the biopsy specimen yielded yellow-green colored, granular mold colonies and creamy white yeast colonies. Microscopic examination of the lactophenol cotton blue stained mold colonies indicated long conidiophores with vesicles surrounded by uniseriate phialides, compatible with Aspergillus flavus. Yeast colonies were identified as Candida guilliermondii by ID32C (BioMerieux, France) and by their microscopical morphology detected in corn meal-Tween 80 agar incubated at 25°C for 72 hours. The patient was treated properly with surgical debridement and itraconazole therapy. Since the immune system is compressed as a consequence of aging, cutaneous opportunistic fungal infections should be considered in the differential diagnosis of posttraumatic necrotic ulcers and black eschar in aged patients.

Amac: Helikobakter pilori (H.pylori) kronik aktif gastrit ve peptik ulserin major etyolojik faktorudur. Fonksiyonel dispepsi (FD), semptomlari aciklayacak kesin yapisal veya biyokimyasal nedeni olmayan epigastrik bolgeye lokalize tekrarlayan veya surekli karin agrisi ve rahatsizlik hissidir.H.pylori eradikasyonunun dispepsi semptomlarina etkisi,henuz tam olarak aydinlatilamamistir. Bu calismada, FD hastalarinda H.pylori eradikasyonun dispepsi semptomlarina kisa donem etkileri arastirilmistir. Gerec ve Yontem: Calisma, FD tanisi almis ve calismaya alinma kriterlerine uyan 167 hastada (99 kadin, 68 erkek) gerceklestirildi. Her hastaya ust gastrointestinal endoskopi yapildi ve mide mukozasindan biyopsiler alindi.H.pilori enfekte cikan hastalara 7 gun sureyle lansoprozol 30 mg 2x1, amoksisilin 1 gr 2x1, levofl oksasin 500 mg 1x1 verildi. Tedaviden 6–8 hafta sonra 14C ure-nefes testiyle tedavinin basarisi degerlendirildi. Hastalarin tedavi oncesi ve sonrasi semptom skorlari sorgulandi. Bulgular: Tedavi sonunda 114 (%68) hastada H.pylori negatifl esirken 53 hasta (%32) pozitifl ik devam etti. H.pylorieradikasyonun saglandigi ve saglanamadigi hasta gruplari, yas ve cinsiyet acisindan benzerdi. H.pylori negatifl esen 114 hastanin 111\'inin (%97.4) semptom skorlari azalma gosterdi, pozitif kalan grupta ise 53 hastanin 38\'inde (%71,7) semptom skorlari geriledi (p = 0.001). Sonuc: H.pylori eradikasyonu, kisa donemde FD semptomlarinda rahatlama saglamaktadir. Uzun donem sonuclari icin yeni calismalara ihtiyac vardir.

Dear Editor, Malignant urine cytology is usually associated with conventional urothelial carcinoma. Here we report a case of lymphoepithelioma-like carcinoma (LELC) that was initially diagnosed by urine cytology and discuss the cytological differential diagnosis. A 75-year-old man presented with haematuria. There was a history of left nephrectomy for urolithiasis and he was radiologically examined for contralateral urolithiasis and any urinary tumours. Radiological examination showed no lithiasis, but a 3 · 3 cm mass at the right wall of the bladder was seen. At the same time a voided urine specimen was sent for cytological examination. The smears were moderately cellular. There were loosely arranged cell clusters and isolated single cells on a haemorrhagic and necrotic background containing lymphocytes, polymorphonuclear leucocytes and umbrella cells. Some cell clusters were infiltrated by lymphocytes (Figure 1). The cells had large, pleomorphic, irregularly contoured hyperchromatic nuclei and a scanty cytoplasm. Large eosinophilic nucleoli were prominent in some of the cells. The features were not typical of the usual malignancies of the bladder. A diagnosis of malignant cytology, concurrent with LELC, was made. After making a cytological diagnosis, cystoscopy was performed and a non-pedunculated, solitary tumour was seen at the right wall of bladder. The remaining mucosa appeared normal. Deep transurethral resection (TUR) and fulguration of the tumour base was performed. On histopathological examination the tumour was composed of sheets and nests of undifferentiated malignant cells arranged in syncytial pattern. Tumour cells contained large pleomorphic nuclei with prominent nucleoli and a scanty, illdefined cytoplasm. They were accompanied by prominent lymphoid reaction consisting of mature lymphocytes and neutrophils (Figure 2). The tumour was invading muscle proper, and necrosis was seen in some areas. TUR material confirmed the diagnosis of pure LELC. LELC of the bladder was classified as a variant of infiltrative urothelial carcinoma in the 2002 consensus conference . Histologically, it is composed of sheets and nests of syncytial cells intermingled with prom-