Description: In the management of Helicobacter pylori -induced gastroduodenal disease, a pilot study at our hospital (St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway) revealed that culture often seemed to fail compared to the polymerase chain reaction (PCR). A more thorough evaluation was therefore undertaken. We included 201 patients referred to upper gastrointestinal endoscopy in the period 2002-2004. Serology, biopsy rapid urease test, culture and PCR were performed. Conventional PCR was performed using the ureC , vacA and cagA genes, and real-time PCR for ureC . A diagnostic standard was defined on the basis of all four tests, and all four tests were then compared to this standard. One hundred eleven patients were deemed H. pylori- positive by the defined diagnostic standard, and 90 were labeled negative. Compared to this standard, culture showed a sensitivity of 87.4%, which was significantly lower than PCR at 99.1% (P〈0.001). Culture showed a perfect specificity of 100%, which was significantly better than PCR at 97.8%. ureC was the gene with the best sensitivity (94.6% in conventional PCR, 97.3% in real-time PCR). vacA sensitivity was 87.4%, which is significantly lower than ureC (P〈0.001). cagA was present in 37.8% of our H. pylori -positive patients. By real-time PCR a significantly lower cycle threshold was observed in antral biopsies than in corpal biopsies, indicating a higher H. pylori DNA template concentration in antral biopsies. PCR-testing for H. pylori is faster and significantly more sensitive than culture. Culture on the other hand was significantly more specific than PCR in our hand.

Description: Intestinal microbiota play an important role in maintaining normal gastrointestinal (GI) function and ensuring that changes in the composition of the intestinal microbiota can promote GI function. The digestive tract is full of bacteria and many of these, including probiotics, are necessary for optimal digestive function. During bacterial gastroenteritis, harmful bacteria invade the digestive tract causing unpleasant symptoms and upsetting the balance between good and bad bacteria. Supplemental probiotics can help restore this balance. Studies have demonstrated that probiotics can often help reduce the severity of symptoms such as diarrhea and may help accelerate recovery. Probiotics are therapeutic preparations of live microorganisms administered in sufficient dosage to be beneficial to health. The therapeutic effects of these microorganisms appear to be strain specific. Primal Defense®, a unique, probiotic , bacterial compound, contains probiotics that support gut flora balance, promote consistent bowel function, control stomach acid levels to quickly eliminate burning sensation in the stomach and maintain immune system response. The probiotics in Primal Defense® maximize the benefits of a healthy diet by supporting normal absorption and assimilation of nutrients in the gut. Nearly 75% of our immune defenses are located in the digestive tract, so maintaining a favorable bacterial balance in the intestines (ideally 80% good or neutral bacteria to 20% bad or harmful bacteria) is crucial to achieving and maintaining optimum health.

Description: Helicobacter pylori consist in a helical shaped Gram-negative bacterium, approximately 3 micrometers long with a diameter of approximately 0.5 micrometers. It has 4-6 flagella. It is microaerophilic and tests positive for oxidase, catalase and urease. With its flagella, the bacterium moves through the stomach lumen and drills into the mucus gel layer of the stomach. In humans, H. pylori have been associated with peptic ulcers, chronic gastritis, duodenitis and stomach cancer. It is widely believed that in the absence of treatment, H. pylori infection, once established in its gastric niche, persists for life. The aim of this research is to study the cultural characteristics and antibiotic susceptibility pattern of H. pylori strains isolated from southwest Nigeria. The cultural characteristics and antibiotic susceptibility pattern of Helicobacter pylori strains isolated from gastric mucosal antral biopsy specimens collected from 43 of 52 dyspepsia patients in the University College Hospital Ibadan, Oyo State, Nigeria, were determined using standard microbiological methods for Helicobacter pylori isolation. The 43 isolates were subjected to 23 different antibiotics and each of the antibiotics demonstrated a variable degree of activity against the isolates. Among the antibiotics to which the organism was most susceptible are: ofloxacin (30 μg) 100% activity, ciprofloxacin (5 μg) 97.67% activity, gentamicin (120 μg) 95.35 activity, amikacin (30 μg), kanamycin (30 μg) and chloramphenicol (30 μg) each 90.70% activity, clarithromycin (15 μg) 93.02, while the less active antibiotics are: augmentin (30 μg) 23.26% active, amoxycillin (25 μg) and metronidazole (50 μg) each 27.91% active and clindamycin (2 mg) 30.23% active. From the result of the antibiotic susceptibility pattern of the strains of the organism, 95.35% of the total isolates are multi drug resistant. Resistance was developed to, among others, augmentin (30 μg), amoxycillin (25 μg), metronidazole (50 μg) and clindamycin (2 mg).

Description: Desmoid tumours are unique mesenchymal neoplasm. They are able to spread to proximal tissues but tend not to metastasize. Our case presents a 66-year-old female referred for evaluation of the prominent, palpable mass located into the left abdomen. Imaging studies revealed a tumour up to 22 cm, extending below the diaphragm to the retroperitoneal and intra-abdominal cavity. Contrast enhanced ultrasound showed strong inhomogeneous arterial hyper-enhancement followed by persistent enhancement in a venous phase. Histology obtained with tru-cut needle biopsy established desmoid tumour, with overall proliferating activity (Ki-67 expression) of 20%. The lesion had been identified as sporadic and ‘unresectable’. During the patient’s follow-up a slow but continuous elevation of serum creatinine was registered eventually led to anuria, requiring emergent haemodialysis. The non-obstructing nephropathy is an unusual complication of the disease course, therefore we briefly reviewed the published data on abdominal desmoid tumours and critically analysed the relation with kidney injury.

Description: Intramural duodenal hematomas (IDA) have rarely been associated with pancreatic diseases. Conservative treatment is recommended but course of disease can be life threatening, serious complications may occur (i.e. duodenal perforation) with imperative surgery. The management of diagnostic and treatment in IDH was improving over the years. Computed tomography (CT) and endoscopic ultrasound (EUS) are excellent tools for diagnosis and follow up of IDH. We report a case of a 31-year-old alcoholic who presented with vomiting, exsiccosis, hypochondriac pain and positive shock index. Esophagogastroduodenoscopy showed gastric outlet obstruction caused by obliterating tumor of bulbus duodeni. Initial suspicion was malign tumor of the duodenum confirmed by native CT and histology. Further diagnostic using EUS-guided aspirate resulted in IDH. By conservative management with nasogastric decompression and digestive rest the patient recovered. In course of disease the hematoma got smaller, but parts were still seen in CT 6 month later.

Description: Bouveret's syndrome is a rare cause of gallstone ileus that occurs more often in the elderly and has a female predominance. In this case report we describe a patient with classic risk factors and typical presentation who underwent one-stage surgical repair without complications. Bouveret's syndrome is a diagnosis that requires a high index of suspicion; diagnosis is often delayed. Advances in imaging have improved diagnostic accuracy, but surgical exploration is required in some cases. Although non-invasive methods of treatment have been utilized with some success, surgery remains the treatment of choice for most patients. However, there is still controversy regarding best surgical approach. Choice of treatment may depend on a patient's underlying co-morbidities and surgical risk factor, age, and likelihood of recurrent symptoms. 

Description: Salmonella Typhi chronically infects the gallbladder and is considered as a predisposing factor for gallbladder cancers. We screen for any Salmonella Typhi isolates present in the gallbladder of 155 patients undergoing cholecystectomy for chronic cholelithiasis in two different regions within the country. Along with microbiological identification, we develop a multiplex PCR assay to speciate the Salmonella spp. Characterisation studies involve determining tolerance to bile, quantifying biofilm forming ability and antibiotic susceptibility testing using disc diffusion assay. Eight (10.66%) of 75 patients (100%) from region in North India (New Delhi) were positive for S .Typhi on culture compared to two (2.5%) of 80 patients from other region in South (Goa). All the isolates had a minimum inhibitory concentration to bile of 4% with minimum bactericidal concentration varying between 4%-6%. Crystal violet assays revealed that the gallbladder isolates showed a quicker and better biofilm masses. Multi-drug resistance (MDR) is common among Salmonella strains but a few gallbladder isolates from the typhoid endemic region possessed a concern with its resistance to fluroquinolones. All the isolates were susceptible to ceftriaxone indicating its possible use in treatment of chronically infected individuals. It was seen that supplementing the media with sub-lethal bile concentrations did enhance the biofilm forming ability of the organism without any significant alterations in the drug resistant patterns. Furthermore, growth in sub-lethal bile concentration also induced similar changes in total protein profiles in all the gallbladder isolates.

Description: Hepatic hemangiomas are benign tumors of the liver which are often found incidentally. We present a 34-years-old man with a two-month history of upper abdominal pain and incidental finding of multiple hepatic masses. The patient sought medical attention at several healthcare facilities where he posed a diagnostic dilemma before he was referred to us. Computed tomographic scan revealed four hypodense hepatic nodules of varying sizes. The nodules demonstrated peripheral enhancement with progressive centripetal filling till they were totally filled during the delayed phase. Abdominal ultrasonography confirmed the four hepatic lesions. The largest lesion was in the left lobe measuring 73×72 mm while the smallest was in the right lobe (24×20 mm). All the masses demonstrated increased vascularity on color Doppler imaging. The paucity of reported cases of hepatic hemangioma in Nigeria, the multiplicity of the tumor and the giant size of one of them make this case remarkable and reportable.

Description: Large spontaneous portosystemic shunts in cirrhosis are implicated in recurrent and/or chronic persistent hepatic encephalopathy. In long standing cases, these shunts lead to portal vein thrombosis and hepatic dysfunction. Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that is usually employed for shunt closure in the patients manifesting the features of chronic hepatic encephalopathy. There are several reports documenting systemic and portal vein thrombosis as a part of the procedure. We report first time a patient in whom the difficult and partial BRTO procedure led to the extensive thrombosis of the large splenorenal shunt itself without sclerosant instillation.

Description: Not available