Sickle-cell disease simulating Burkitt's lymphoma: case report.
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Biomedical subjects
Publications and source records attributed to C Holcombe.
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In a study of forty asymptomatic volunteers from northern Nigeria; 35 (87.5%) had histological gastritis and 32 (80%) were infected by Helicobacter pylori. All but one of the patients infected by Helicobacter Pylori had histological gastritis. This high prevalence of H. Pylori infection in young, asymptomatic subjects, occurs in an area with a low prevalence of duodenal ulcer. The possible reasons for this are discussed.
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One hundred and thirty north Nigerian patients with non-ulcer dyspepsia were treated with tripotassium dicitrato bismuthate and amoxycillin, or antacid. Symptoms resolved in 28 (33%) of bismuth and amoxycillin recipients completing the trial compared with 1 (4%) of the antacid recipients. Symptomatic improvement did not relate to clearance of Helicobacter pylori.
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This study was carried out to determine the prevalence of antibodies to Helicobacter pylori in northern Nigeria, a region with a low incidence of peptic ulceration. In a random, serological survey of 268 subjects, 228 (85%) of the population studied had IgG antibodies to H. pylori. Fifty-eight of these subjects had experienced dyspepsia in the preceding 6 months. The majority of the population (82%) is infected between the ages of 5 and 10. Despite the high prevalence of antibodies to H. pylori, peptic ulcer is uncommon, suggesting that H. pylori is not important in the etiology of peptic ulcer in this population. Indeed, most patients infected by H. pylori are asymptomatic. The possible reasons for this are discussed.
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In 4 years, 200 patients were admitted to the University of Maiduguri Teaching Hospital, in the Northern Savannah of Nigeria, with a clinical diagnosis of peptic ulcer; 60 had the diagnosis of duodenal ulcer confirmed on barium meal or at operation, giving an incidence of 6/1000 adult admissions (excluding obstetrics). There were no gastric ulcers. Forty-four patients had a 'simple ulcer', 10 presented with gastric outlet obstruction, five with peritonitis following perforation and one with haematemesis. There were 44 males, and 16 females, with a mean age of 34 years and mean length of history of 44 months. Contrary to previous published reports improved diagnostic facilities have shown duodenal ulcer to be relatively common in the Northern Savannah of West Africa.
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Epigastric pain is a common complaint throughout Africa, mostly in the form of non-ulcer dyspepsia. It has recently been suggested that Helicobacter (= Campylobacter) pylori, a bacterium that colonizes the gastric mucosa and causes type B gastritis, may be the cause of this epigastric pain. This paper reports the endoscopic, histological and bacteriological findings in 57 patients presenting with epigastric pain to the University of Maiduguri teaching hospital during one year, together with a review of the African literature. Of 57 patients, 49 had non-ulcer dyspepsia, 7 peptic ulceration and 1 carcinoma of the stomach. 93% of the patients had histological gastritis, and of these 87% were colonized with H. pylori. The bacterium was cultured from 13 patients. This high prevalence of gastritis and H. pylori has been found throughout Africa. The figures support a causative role for H. pylori in histological gastritis. At present the evidence in support of a causative role in non-ulcer dyspepsia is not strong enough to be able to recommend the routine use of anti-H. pylori therapy in patients with epigastric pain.