As both groups of patients, the previously published SOT patients and the present hematopoietic SCT patients, were monitored using the same protocol and qPCR assay with pre-emptive therapy administered at the same VL cutoffs, the distinct differences seen cannot be explained by differences in testing or management and thus emphasize distinct aspects of the natural history of CMV infection post transplant in these 2 patient groups.

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Despite lack of rationale for the use of a combination of quinolones and anti-protozoal agents in the management of acute diarrhea in India; it is the most common prescription. These brands have a large market share of >200 crores and there are >70 brands. This combination is a very "Indian" and does not fi gure in any standard pharmacopoeia.There is no rationale for the use of combinations of quinolones and anti-protozoal in patients with acute diarrhea due to the following reasons. Most acute diarrheas in adults are self-limiting, and require only oral rehydration therapy. Antibacterials like quinolones are required in certain specifi c situations. Anti-protozoals are not routinely indicated as giardia and ameba are uncommon causes of acute diarrhea.Studies from the CIWEC clinic in Nepal, a CDC accredited center evaluating nearly 2000 cases of acute diarrhea every year, have shown that amebic and giardial infection constitute only 1% each of all acute diarrheas. 1 Studies from Indonesia in 3875 adults with acute diarrhea also show similar results. 2,3 Black et al also showed that amongst 179 Indian children with acute diarrhea, only 2% had giardial infection and none had amebic infection. 4 Thus, acute onset diarrhea occurring within <7 days after an unhygienic food exposure, especially if associated with fever and vomiting is highly unlikely to be of protozoal etiology. Amebic or giardia infection warrant treatment for 7-10 days instead of 5 days as required for bacterial infections. Most patients, prescribed this combination, do not complete the course of treatment because of side effects of the imidazole group of drugs, thus defeating the purpose of therapy.Rational use of all drugs is a cornerstone for good clinical practice. When evidence-based medicine seems to be the order of the day, we still seem to go by "gut feelings of the doctors". It is high time we look at this issue squarely and decide what is best for our patients.Adenocarcinoma of the stomach represents more than 90% of gastric malignant tumors. The liver is the most common location of hematogenous metastasis. 1 The large intestine is an unusual site of metastasis from gastric adenocarcinoma. Although direct extension of infi ltrating gastric cancer through the gastrocolic ligament into the transverse colon appears to be the commonest type, metastases extending from the ileocecal valve to the sigmoid colon are rare. Stomach adenocarcinoma causes metastases usually within 5 years after gastrectomy. After this period, tumor recurrence is unusual and is estimated to be 6.2 %.We report a 73-year-old woman who presented with chronic diarrhea, with a history of gastric adenocarcinoma diagnosed 8 years ago. In 1999, a stage IIIb, poorly differentiated, adenocarcinoma of the stomach was diagnosed and the patient was treated with total gastrectomy, splenectomy and esophago-jejunal Roux-en-Y anastomosis followed by course of chemotherapy. Histology of the resected specimens revealed a poorly differentiated ulcerous adenocarcinoma, of mixed-type both dif...

There is evidence that Helicobacter pylori eradication might predispose to gastroesophageal reflux disease (GERD). The aim of this prospective study was to examine the effectiveness of antisecretory treatment, after successful H. pylori eradication, in preventing GERD, since no data exist so far. Eighty initially H. pylori(+) patients, without GERD at the time of H. pylori eradication [50 peptic ulcer (PU) and 30 nonulcer (NU), 55 men, 25 women, median age 38 years, range 19-57], after successful H. pylori eradication were randomized to recieve either omeprazole 20 mg daily (group A) or no treatment (group B) for one year. All patients underwent upper gastrointestinal endoscopy at 0, 6, and 12 months or when GERD symptoms occurred. There were 40 patients in each group, and there were no statistically significant differences between the two groups in terms of sex, age, body weight, ulcer/no ulcer ratio, and other demographic data. Seven patients from group A and five patients from group B were lost to follow-up, and therefore there were 33 and 35 patients in groups A and B, respectively, who completed the study. One of 33 patients in group A (3%) and 10/35 (28.5%) in group B developed GERD symptoms during follow-up (P = 0.0022). The respective values for esophagitis were 0/33 (0%) and 6/35 (17.1%) (P = 0.0083). In conclusion, antisecretory treatment in H. pylori(+) patients, after successful eradication, is effective in preventing GERD.

A 26-year-old man with an unremarkable medical history presented with arthralgia and abdominal pain. Two days after admission, while under investigation for multiple arthritis, he suffered hematochezia, weakness, and low blood pressure. Esophagogastroduodenoscopy showed no abnormalities, but colonoscopy and retrograde ileoscopy revealed clots of blood through the whole enteric lumen. No sign of active bleeding was found. Mesenteric angiography was normal. Capsule endoscopy was performed 2 days later and revealed findings compatible with enteric ischemia (necrotic areas of mucosa, diffuse ulceration and blood in the lumen), mainly in the ileum (• " Figs. 1, 2;• " Video 1). A few days later, due to severe deterioration of his condition (acute abdomen), the patient underwent surgery. Surgical exploration revealed intraluminal inflammation, ulcerations, and necrotic areas in several sites in the ileum, in agreement with the findings of capsule endoscopy. A partial enterectomy with ileostomy was performed. Histological examination of the resected ileum showed injuries to the enteric wall and the mesentery of the terminal ileum compatible with necroticgranulomatous vasculitis of small and intermediate-sized vessels (Wegener's granulomatosis) (• " Figs. 3, 4). During the postoperative follow-up, the patient is doing well. We emphasize the role of capsule endoscopy: (i) in finding the cause of the gastrointestinal bleeding, (ii) in guiding the surgeon to surgical intervention when a serious clinical entity appeared, and (iii) in the early diagnosis of ischemic-necrotic enterocolitis even in this rare case of intestinal involvement in Wegener's granulomatosis.