Serum levels of AT-III, D-D and CRP at admission appear to be useful biomarkers for assessing the severity of CAP.

Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies and can be either congenital or acquired. Acquired double pylorus is usually an uncommon complication of peptic ulcer that erodes and creates a fistula between the duodenal bulb and the prepyloric antrum. We describe a case of a 67-year-old man who experienced mild epigastric pain and dyspepsia over the last 6 months. The patient periodically took nonsteroidal anti-inflammatory drugs (NSAIDs) due to joint pain. Esophagogastroduodenoscopy revealed gastritis and a double pylorus. An accessory channel connected the lesser curvature of the prepyloric antrum to the duodenal bulb and the endoscope was able to be passed through both of the ducts. The Helicobacter pylori quick test proved positive. Two years later, a follow-up endoscopy showed that fistula fused with normal pylorus and there was a single large opening.

IntroductionPrimary hyperaldosteronism is only rarely caused by unilateral adrenal hyperplasia.Case presentationA 73-year-old hypertensive Greek man (on 10 mg amlodipine for the last ten years) presented in the emergency department with severe muscle weakness of all limbs. The initial physical and laboratory examination revealed normal blood pressure, muscle weakness, severe hypokalemia, sinus rhythm and U wave, rhabdomyolysis and metabolic alkalosis. The patient was immediately treated with intravenous administration of potassium-rich solutions, 25 mg spironolactone with progressive dose titration up to 100 mg. Because of high arterial blood pressure, irbesartan was added. On day 6, muscle weakness was completely restored with decrease of arterial blood pressure and further improvement of laboratory tests. The combination of hypokalemia with arterial hypertension raised the suspicion of primary hyperaldosteronism; therefore, we performed abdomen computed tomography scan, which revealed a nodular mass (15 mm in diameter) in the left adrenal gland. Plasma renin activity was in the lower normal range with a three-fold increase of plasma aldosterone concentration. We performed total resection of the left adrenal gland and the histopathological examination revealed hyperplasia of the left adrenal gland.ConclusionThis report presents a rare case of an elderly patient under antihypertensive treatment the last ten years for essential hypertension, who admitted to our emergency department with hypokalemia - induced myopathy as first manifestation of primary hyperaldosteronism due to unilateral adrenal hyperplasia.

In northern Greece, persons aged over 40 years are prone to ANMUGIB with a non-significant relationship to males. Hp infection and medication use, such as NSAIDS and L-A, are deeply involved in its etiology. Non-Hp non-NSAID/L-A BPU are a small proportion. ANMUGIB seems to have a generally good prognosis.