No abstract

No abstract

No abstract

International guidelines for the management of Helicobacter pylori infection recommend eradication therapy with a proton pump inhibitor and two antibiotics chosen from amoxicillin, a nitroimidazole (metronidazole or tinidazole) and clarithromycin. 1 The use of such triple therapy regimens is underpinned by large randomized trials. In the metronidazole, amoxicillin, clarithromycin, H. pylori, 1-week therapy (MACH 1) study, for example, eradication rates (intention-to-treat analysis) ranged from 75.8% (95% CI, 68.3-83.3) with a twice-daily regimen consisting of omeprazole (20 mg), amoxicillin (1000 mg) and metronidazole (400 mg) given for 1 week, to 90.6% (95% CI, 85.3-95.9) with omeprazole (20 mg) plus amoxicillin and clarithromycin (500 mg each).2 Furthermore, the subsequent MACH 2 study con®rmed that such triple regimens achieve higher eradication rates, reduce the impact of primary antibiotic resistance and may decrease the risk of secondary resistance, compared with regimens consisting of two antibiotics only.3 As a result, such triple regimens now represent the`gold standard' for the eradication of H. pylori.In France, the most widely used triple regimen consists of omeprazole, amoxicillin and clarithromycin. The omeprazole, clarithromycin and metronidazole regimen

We report two cases of early primary hepatocellular carcinoma (PHC) in children, after probable maternal transmission of hepatitis B, that were treated with orthotopic liver transplantation (OLT). Both children were 8.5 years old and had elevated levels of serum alpha-feto-protein. The diagnosis of PHC was made at 8 years and confirmed histologically. Serum hepatitis B surface antigen (HBs Ag) was detected in the mothers and suggested vertical transmission. An attempt at complete liver tumor resection failed, leading to OLT. In order to prevent recurrence of the hepatitis B virus (HBV) infection, hepatitis B immunoprophylaxis was used. Two years after OLT, one child presented with recurrent HBV infection. No tumor recurrence was observed at follow-up in either of the patients. From these two cases we conclude that (1) HBV infection may play an important causal role in PHC in children, with an even shorter incubation period than that in adults; (2) close follow-up is needed for children who are HBs Ag-positive carriers; and (3) liver transplantation should be proposed early after the diagnosis of PHC, when tumor resection is not feasible.