Background: The aim of this study was to investigate the diagnostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in infective endocarditis (IE) and to correlate them with the etiology of the disease and the prognosis of the patients. Methods: Fifty patients who were diagnosed as having IE based on Duke criteria (major and/or minor) were included in the study at the Istanbul University Cardiology Institute and Florence Nightingale Hospital. Forty patients with bacteremia (non-IE) and 50 healthy blood donors were also included in the study as the control group. During the 45 days of medical follow-up, in those patients who had a response to medical therapy based on the results of left ventricular function tests, transesophageal echocardiography (TEE) and culture, among other factors, PCT and CRP levels were measured in 5-cm³ blood samples obtained without anticoagulant when they were first admitted (day 0), as well as 24 h and 15, 30 and 45 days after admission. In the patients who had valve replacement, 5-cm³ blood samples without anticoagulant were similarly obtained on the day of admission, after 24 h and/or on the 15th day, and 1 day before and on the 2nd and 5th days after the operation. Results: In this study, a significant difference (p < 0.001) was found between the IE group and the healthy control group with respect to their serum PCT and CRP levels at the time of admission. No significant difference was found between IE and non-IE groups (p > 0.05). The sensitivity of PCT in comparison to CRP was found to be lower (84 vs. 100%); however, its specificity was determined to be higher (88 vs. 72%). The median values of serum PCT in the nonoperated and operated cases at the time of admission, after 24 h and on the 15th day were 3.71, 5.35 and 0.44, and 2.45, 4.28 and 4.22 ng/ml, respectively, and those of CRP were 9.30, 10.95 and 10.65, and 9.5, 10.9 and 10.2 mg/dl, respectively. The median values of serum PCT were found to be higher in cases with IE and non-IE related to gram-negative bacteria than those related to gram-positive bacteria (p < 0.02). This was found to be insignificant for CRP (p > 0.05). Conclusions: As a result, this study suggests that in the diagnosis of IE, it would be beneficial to use PCT, besides TEE, culture and other clinical criteria, for its high specificity and positive predictive value in comparison to CRP. This study also suggests that in determining the response to medical treatment in the follow-up period, PCT could be a more valuable parameter than CRP, as PCT has a high prognostic value and is a good indicator for valve replacement in addition to the major criteria. Furthermore, serum PCT levels may help the physician to decide on the antimicrobial therapy combination before obtaining the culture results, or in situations in which the agent could not be isolated yet.

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BACKGROUND AND PURPOSE:Tinnitus is a common disorder, and the etiology remains mostly unclear. The purpose of this study was to investigate the causative effect of the vascular loop and compression of the vestibulocochlear nerve at the cerebellopontine angle in patients with unexplained tinnitus.

The aims of this study were to determine the levels of procalcitonin (PCT) and C-reactive protein (CRP) in Helicobacter pylori-positive (HP þ ) patients diagnosed with duodenal and gastric ulcer and to evaluate the correlation of PCT and CRP levels with other invasive and non-invasive diagnostic methods for determination of H. pylori eradication in post-treatment follow-up. Thirty-five HP þ patients with dyspepsia were included in this study. Serum samples (5 ml) were collected at admission and after 24 h. Antimicrobial therapy (omeprazole, amoxycillin and clarithromycin) was given for 1 week to HP þ patients who were positive only by culture or by urease test plus pathology.After 1 month, serum samples (5 ml) were collected again and culture, urease and pathology investigations were performed on endoscopic samples. PCT and CRP levels were measured in the collected blood samples. Thirty-five H. pylori-negative (HP À ) cases with dyspepsia, 38 cases with bacteraemia and 35 healthy blood donors were included in this study as control groups. The mean and minimum-maximum levels of PCT were 1 . 39 (0 . 25-6 . 75), 0 . 35 (0 . 12-0 . 71), 7 . 45 (0 . 68-51 . 5) and 0 . 40 (0 . 12-0 . 71) ng ml À1 for the groups of HP þ , HP À and bacteraemia patients and healthy donors, respectively. Mean CRP levels were 1 . 00 (,0 . 5-8 . 11), 0 . 62 (,0 . 5-3 . 2), 11 . 5 (3 . 2-43 . 5) and 0 . 63 (,0 . 5-5 . 46) mg dl À1 for the same groups. A statistically significant difference was found between HP þ patients and both HP À cases and healthy blood donors for PCT levels, and higher PCT levels were found on admission in cases of bacteraemia than in the other groups (P , 0 . 05). PCT levels of HP þ cases decreased significantly (from 1 . 39 to 0 . 86) between admission and the post-treatment period (30 days); however, PCT levels remained higher than the cut-off value (0 . 5 ng ml À1 ). Similar ranges of CRP levels were found over the same time-period. The sensitivity of PCT was found to be higher than that of CRP on admission, but the specificity of PCT was found to be lower than that of CRP on the day of admission (65 and 74 %, respectively). The sensitivity of PCT was the same as that of CRP for the post-treatment period, but specificity of PCT was higher than that of CRP for the post-treatment period (83 and 76 %, respectively). It was concluded that PCT and CRP are not very effective markers for H. pylori infection in primary diagnosis or in eradication follow-up after therapy when used in parallel with conventional diagnostic methods, even if there is a difference in PCT and CRP levels between HP þ and HP À cases on admission.

Dicrocoelium dentriticum (D. dentriticum) is a liver fluke induced biliary obstruction. Infection usually occurs in herbivores such as sheep, goats and deer; human infection is very rarely encountered in clinical practice. We report on a 65-y-old female presenting with biliary obstruction caused by D. dentriticum. Following treatment with triclobendazole, her symptoms disappeared, and laboratory values returned to normal range within 6 months. Parasitosis is an important cause of biliary obstruction. We suggest that for patients presenting with biliary obstruction, D. dentriticum should be included in the differential diagnosis.