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Gastric metastasis of choriocarcinoma is rarely reported in the literature. This case report presents the case of multiple metastatic testicular choriocarcinoma mimicking gastric cancer, with melena as the initial symptom. In this case, 18 fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) showed that the testis was the primary focus. The contribution of PET/CT is significant to primary focus detection in metastatic diseases of unknown primary origin that presented gastrointestinal bleeding. In addition to its use in staging of testicular carcinoma, PET/CT provides significant benefit in evaluating patients with increased levels of tumor markers and in detecting recurrence.

Objective: To compare the patients' compliance with and the efficacy of existing treatments for Helicobacter pylori eradication, including moxifloxacin-based triple therapy, sequential treatment and the standard treatment., Methods: Patients with H. pylori infection were randomly assigned to three therapy groups. The triple therapy (MML) group was given moxifloxacin 400 mg/day, metronidazole 500 mg b.i.d. and lansoprazole 30 mg b.i.d. for 10 days. The sequential treatment (AL-CML) group was administrated amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. for the first 5 days, followed by clarithromycin 500 mg b.i.d., metronidazole 500 mg b.i.d. and lansoprazole 30 mg b.i.d. for the second 5 days. The standard treatment (CAL) group received amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d. and lansoprazole 30 mg b.i.d. for 14 days. The eradication rates were evaluated by per-protocol (PP) analysis and intention-to-treat (ITT) analysis., Results: The eradication rates were 87.1, 85.9 and 85.2% by PP analysis and 87.1, 84.9 and 84.2% by ITT analysis in the MML, AL-CML and CAL group, respectively, and patients' compliance rates were 98.2, 96.5 and 97.1%, respectively. There were no significant differences in treatment efficacy and compliance rates in the MML, AL-CML and CAL groups (P > 0.05)., Conclusions: The present study revealed that standard triple therapy, sequential therapy and moxifloxacin-based triple therapy are all effective treatment regimens in terms of H. pylori eradication rates and compliance with therapy in Turkey., (© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Objective: Irritable bowel syndrome (IBS), a subgroup of functional somatic disorders, may be associated with autonomic dysfunction (AD). Heart rate variability (HRV), a measure of autonomic dysfunction, may predict survival. The aim of this study was to investigate the effect of IBS on HRV parameters, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) as surrogates of AD, subclinical atherosclerosis and arterial stiffness, respectively., Methods: Our study was cross-sectional and observational. Thirty consecutive patients with IBS and 30 control participants underwent 24-hour Holter monitoring, cf-PWV assessment and CIMT measurement. The diagnosis of IBS was based on Rome III criteria. There were 24 patients with IBS-Constipation (80%), 4 patients with IBS-Diarrhea (13.3%), and 2 patients with IBS-Mixed (6.7%) in IBS group. Student t-test and χ2 test were utilized in order to compare continuous and categorical variables between two groups, respectively., Results: Biochemical parameters did not differ between groups except for slightly increased creatinine in patients with IBS. cf-PWV and CIMT values were similar between groups. SDNN index and RMSSD were significantly impaired in patients with IBS compared to controls. Frequency analyses revealed lower LF, HF, and VLF in subjects with IBS., Conclusion: We demonstrated decreased parasympathetic modulation in patients with constipation predominant IBS. However, we could not demonstrate any changes in vascular structure and functions measured by carotid intima-media thickness and pulse wave velocity. Our results do not support accelerated atherosclerosis in IBS population.

Background: Ulcerative colitis (UC) is characterized with chronic, progressive inflammation of the gastrointestinal tract. The association of UC with cardiovascular disease is still a matter of debate., Aim: The aim of this study was to investigate whether carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) as surrogates of atherosclerosis and arterial stiffness are increased in patients with UC., Methods: Our study was cross-sectional and observational in design. Baseline characteristics were recorded during interview with the patient. Patients with previous cardiovascular disease, rheumatoid arthritis, chronic renal failure, and infectious and inflammatory disorders other than UC were excluded. Thirty-seven consecutive patients with UC and 30 control participants underwent cf-PWV assessment and CIMT measurement. The diagnosis of UC was based on clinical, radiologic, endoscopic, and histological findings., Results: CIMT, cf-PWV, and C reactive protein were significantly higher in patients with UC. Although linear regression analyses identified UC as an independent predictor of CIMT (β ± SE, 0.39 ± 0.08; p < 0.001), only age independently predicted cf-PWV (β ± SE, 0.08 ± 0.03; p = 0.003) in our study population. Moreover, we revealed higher CIMT and PWV values in patients with higher disease activity and more extensive involvement, compared to patients with mild activity and limited disease., Conclusion: We revealed increased pulse wave velocity and CIMT in patients with UC. UC appears to be associated with arterial stiffness and atherosclerotic burden, but the underlying mechanisms require further studies to be identified.

Portal vein thrombosis (PVT) can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.