bluuebunny/crossref_metadata_2025 huggingface dataset:
Ileocolonic Schistosomiasis Resembling Crohn’s Disease
Authors: Gardiner Geoffrey W , Zalev Arthur , Warren Ralph
Published: March 2016

A case of ileocolonic schistosomiasis mimicking Crohn’s disease of the ileum is presented. Surgical resection of ileum was performed in a 40‐year‐old man because of intestinal obstruction with fistulas, which were diagnosed surgically and histologically as Crohn’s disease. It was only with tissue review six months later that the diagnosis of ileal schistosomiasis was made. The difficulties in diagnosis and recognition of this disease are discussed.
Intestinal Permeability: The Basics
Authors: Bjarnason Ingvar , Macpherson Andrew , Menzies Ian S
Published: March 2016

The authors review some of the more fundamental principles underlying the noninvasive assessment of intestinal permeability in humans, the choice of test markers and their analyses, and the practical aspects of test dose composition and how these can be changed to allow the specific assessment of regional permeability changes and other intestinal functions. The implications of increased intestinal permeability in the pathogenesis of human disease is discussed in relation to findings in patients with Crohn’s disease. A common feature of increased intestinal permeability is the development of a low grade enteropathy, and while quantitatively similar changes may be found in Crohn’s disease these seem to predict relapse of disease. Moreover, factors associated with relapse of Crohn’s disease have in common an action to increase intestinal permeability. While increased intestinal permeability does not seem to be important in the etiology of Crohn’s disease it may be a central mechanism in the clinical relapse of disease.
Treatment of Fulminant Hepatic Failure – Is There Light at the End of the Tunnel?
Authors: Kaita KDE
Published: March 2016

A lot of research has been done on fulminant hepatic failure (FHF), mainly because of the high mortality associated with it. Many centres continue to search actively for the ideal medical treatment for FHF because liver transplantation is often difficult in these very ill patients. The many forms of therapy that have been tried and reported in case reports, small clinical trials and the occasional randomized controlled trial are reviewed, as are the current data on bioartificial livers and isolated hepatocyte transplantation. The ideal treatment remains elusive, and more work needs to be done to find a highly effective form of therapy for these very ill FHF patients.
Gut‐Brain Interactions in Inflammatory Bowel Disease: A Clinician’s Perspective
Authors: Bayless Theodore M
Published: March 2016

While most physicians and some patients consider psychosocial factors important in aggravating already existing inflammatory bowel disease (IBD), most of the information is based on a few recent scientific studies, varied anecdotal observations and a tendency for patients and some physicians to view psychosocial and stress‐related issues with speculation, bias and some stigmatization. Patients with proctitis who have experienced recrudescence of mucosal friability and rectal bleeding within a day of a severe life stress provide a dramatic example of such anecdotes. Time‐lag studies have indicated that stress, especially major life events, precedes illness aggravation in patients with IBD but that stress is not disease‐specific. The symptoms studied, pain and diarrhea, were more likely to be physiological responses to acute stress rather than reflections of increased disease activity. Current scientific research supposes the prospect that environmental factors influence disease susceptibility through the central nervous system. Stress is associated with alterations in both humoral and cellular immune mechanisms in humans and in experimental animals. While psychosocial factors may not initiate inflammation in IBD, it is possible that they lead to alterations in the immune response and thereby alter disease activity. Mind‐gut interactions affect salivation, gastric secretion, gastric motility and colonic motility, as well as numerous other gastrointestinal functions. These ‘physiological’ responses are expected in the IBD patient and perhaps will be accentuated by inflammation and its multiple effects on gut function. Because 10 to 13% of the general population have a tendency to suffer from irritable bowel syndrome (IBS), it is expected that the same percentage of IBD patients will have both IBD and IBS. An example of clinically relevant alterations in pathophysiology is the association of acute proctosigmoiditis with an increase in IBS symptoms in the left colon. Pain and diarrhea based on distension of an irritable left colon after ileocolonic resection result from excessive distension of the left colon by the larger stool volume following loss of absorptive surface of the ileum and right colon. Patients with IBS are also more symptomatic with small amounts of unabsorbed carbohydrates, such as fructose, sorbitol and lactose. Patients with severe IBS have an irritable small bowel, especially when it is formed into a closed reservoir, such as an ileoanal pouch; these patients have at least eight to 10 bowel movements per day because of the spasticity and small capacity of the ileoanal pouch. The stomach to pouch transit time may also be quite rapid. Explaining the coexistence of IBD and IBS to the patient is often quite helpful to the patient and to the doctor. One hopes that the scientific explanations of these mind‐gut interactions are forthcoming.
Atypical Perinuclear Antineutrophil Cytoplasmic Antibodies in Patients with Crohn’s Disease
Authors: Freeman Hugh J
Published: March 2016

Atypical perinuclear antineutrophil cytoplasmic antibodies (p‐ANCA) occur in most patients with ulcerative colitis but only in a minority of those with Crohn′s disease. In a recent study from the United States, this serological marker was reported to be present in 100% of Crohn′s disease patients with a clinical phenotype of ′left‐sided ulcerative colitis′ but was not present in patients with ′isolated′ small bowel disease. In a previously reported survey from the author′s hospital, the p‐ANCA status of 247 consecutive patients with Crohn′s disease was evaluated, and, of these, 33 Crohn′s disease patients were seropositive, including 18 (13.0%) with combined small and large bowel disease, 11 (19.6%) with ′isolated′ colorectal disease, and four (4.6%) with ′isolated′ small bowel but no detectable colorectal disease. To further evaluate and verify the significance of atypical p‐ANCA in these 33 patients, clinical, radiological, endoscopic and histological features were examined. This study confirms that an ′ulcerative colitis‐like′ clinical phenotype may be seen in most, but not all, serologically positive Crohn′s disease patients. Moreover, ′isolated′ small bowel disease in the absence of colorectal disease occurs. Detection of atypical p‐ANCA in Crohn′s disease with different clinical and pathological features provides serological evidence that Crohn′s disease is a very heterogeneous disorder.
Budesonide in the Management of Patients with Crohn’s Disease
Authors: Thomson ABR , Sadowski Daniel , Jenkins Robert , Wild Gary
Published: March 2016

Modern medical therapy is increasingly based on evidence. The evidence presented here is that budesonide (Entocort, Astra Pharma) 9 mg/day is superior to placebo and equivalent to systemically active glucocorticosteroids in achieving disease remission in patients with active Crohn′s disease, and in prolonging the recurrence time of symptomatic disease. Budesonide causes less disturbance to adrenal function than prednisone or prednisolone and may cause fewer steroid‐associated symptoms. Thus, budesonide is the safer, more effective steroid of choice to treat patients with Crohn′s disease.
Health Research in the Developing World: A Gastroenterological View from Bangladesh
Authors: Hamilton J Richard
Published: March 2016

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that while prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centred in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.
Nausea, Vomiting and Diarrhea: An Unusual Presentation of Multiple Sclerosis
Authors: Szilagyi Andrew , Schipper Hyman M , Just Norman
Published: March 2016

The case of a young woman who presented with nausea, vomiting and diarrhea is outlined; the etiology turned out to be a first attack of multiple sclerosis. Plausible mechanisms are discussed.
Maintenance Therapy for Inflammatory Bowel Disease: What Really Works
Authors: Sutherland Lloyd R
Published: March 2016

The propensity of inflammatory bowel disease sufferers to experience recurrent episodes or disease flares is well documented. Until a cure can be found, strategies to lengthen the period of remission offer the greatest opportunity to reduce morbidity and enhance patient quality of life. Therapies that have been shown in randomized, controlled, double‐blind clinical trials to either lengthen the time of remission or improve the odds of staying in remission during a set time interval are required.
Management of New Symptoms of Dyspepsia in the Elderly in Quebec
Authors: LeLorier Jacques , Pagé Véronique , Castilloux Anne-Marie , LeLorier Yvette
Published: March 2016

OBJECTIVE: To use the Régie de l′assurance‐maladie du Québec (RAMQ) database to study the clinical strategies used by Quebec physicians in the management of dyspepsia in the elderly.

DESIGN: A 20% random sample of the RAMQ database for Quebec residents aged 65 years and older for the three years from July 1, 1991 to June 30, 1992 was used. Patients were placed in three cohorts according to the following treatment strategies: endoscopy, x‐ray examination or drug therapy. Patients in each cohort were then categorized as either nonsteroidal anti‐inflammatory drug (NSAID) users or non‐NSAID users. The choice of drug treatment used to manage the dyspepsia in each cohort was recorded. Drug treatments were divided into the following six antidyspeptic categories: H2 blockers, omeprazole, sucralphate, misoprostol, prokinetic drugs or no drugs. The number of duodenal, oesophageal and stomach cancers diagnosed in each cohort was also counted.

RESULTS: Drug therapy was the most frequently used strategy in all patients, and was used more frequently in NSAID users (87%) than in non‐NSAID users (69%). A total of 22% of NSAID users in each group, and 46% of NSAID users in the drug therapy group, underwent investigation. H2 blockers were the most prescribed drug in all three treatment strategies, and omeprazole was the second most prescribed drug in the endoscopy and x‐ray cohorts. Overall omeprazole was the least prescribed drug. There was a higher rate of cancer detection in the endoscopy and x‐ray cohorts than in the drug therapy group.

CONCLUSIONS: Previous NSAID use greatly influences the way in which physicians treat patients with dyspepsia.
Dietary Fads and Gut Mysteries Versus Nutrition with a Grain of Common Sense
Authors: Mishkin Barry , Mishkin Seymour
Published: March 2016

Although nutritional self‐help literature is directed at the general public, which usually allows the authors to evade critical review by the medical and scientific community, both doctors and lay people need to read with discernment and educated scepticism when major health claims are made. Many published claims are based on misconceptions and questionable logic, and it is important to be aware of the inconsistencies and wrong conclusions commonly found in dietary fads. Patients′ questions and dietary practices over the past few years have helped the present authors become familiar with certain food fads and nutrition ′self‐help′ books, and develop responses to popular gut topics such as food allergies, food combinations and commercial food supplements. The authors also discuss whether fads can deliver on their promises and what to tell patients.
Small Bowel Review - Part I
Authors: Thomson ABR , Jarocka-Cyrta E , Faria J , Wild GE
Published: March 2016

The small bowel has undergone intense study. Part I of this two-part review of the small bowel focuses on gastrointestinal peptides; intestinal infections and human immunodeficiency virus; drugs; intestinal growth - mucosal proliferation and differentiation; nucleic acids, nucleotides and nucleosides; vitamins and minerals; Whipple's disease; radiation; and early development.
Small Bowel Review ‐ Part II
Authors: Thomson ABR , Jarocka-Cyrta E , Faria J , Wild GE
Published: March 2016

The small bowel has undergone intense study. Part II of this review of the small bowel summarizes the current knowledge about the permeability of the gastrointestinal epithelium; the brush border membrane; motility; carbohydrates; diabetes; ethanol; diet; and diagnostic procedures.
Smoking and Diseases of the Gastrointestinal System: An Epidemiological Review with Special Reference to Sex Differences
Authors: Ashley Mary Jane
Published: March 2016

Smoking increases the risk of peptic ulcer disease and death from it. Smoking delays peptic ulcer healing, with or without treatment, and increases the risk of recurrence after healing. The effects of smoking on this disease are similar and equally pervasive in women and men. There is growing evidence that cigarette smoking is a risk factor for Crohn′s disease (CD) in both women and men. However, women smokers appear to be at particular risk for this disease. In studies that examined this risk separately in women and men, at each level of smoking the excess risk in women smokers compared with nonsmokers clearly exceeded the excess risk in men smokers compared with nonsmokers. Smoking also appears to adversely affect the clinical course of CD in both women and men, but more so in women. The possible interaction between smoking and oral contraceptives with regard to the risk of CD deserves further study. There is growing evidence that current smoking protects against ulcerative colitis in both men and women. Although there is some evidence that smoking is a risk factor for gallstones, particularly in women, evidence to support a causal relationship is inadequate. Further studies, controlling for alcohol consumption in the analyses, are needed. Smoking does not appear to be a risk factor for cirrhosis of the liver.
Pilot Study of Ofloxacin and Interferon-Alpha Combination Therapy for Chronic Hepatitis C without Sustained Response to Initial Interferon Therapy
Authors: Komatsu Masafumi , Ishii Tohru , Ono Tsuyoshi , Hoshino Takao , Kuramitsu Tomoyuki , Goto Takashi , Fujii Tomoo , Toyoshima Itaru , Chiba Mitsuro , Masamune Osamu
Published: March 2016

A controlled trial comparing combination therapy with ofloxacin (OFLX) and interferon (IFN) versus IFN monotherapy was conducted in patients with chronic hepatitis C who failed IFN therapy. Twenty patients were assigned randomly to two groups. Equal doses of recombinant IFNα-2b were administered to each group for 24 weeks. For the IFN plus OFLX group, OFLX was administered for 12 weeks at a daily dose of 600 mg. Levels of hepatitis C virus RNA declined significantly from the first month after the start of IFN treatment compared with those before administration in both groups. Serum alanine aminotransferase levels were significantly lower in the IFN plus OFLX group at two and six months after the start of treatment than levels in the IFN group. The fraction of subjects whose levels of serum ALT normalized was also higher in the IFN plus OFLX group. Larger clinical trials should be undertaken.
Prospective Evaluation of Neutrophil Autoantibodies in 500 Consecutive Patients with Inflammatory Bowel Disease
Authors: Freeman Hugh , Roeck Brenda , Devine Dana , Carter Cedric
Published: March 2016

Previous studies have shown antineutrophil cytoplasmic autoantibodies (ANCA) in patients with inflammatory bowel disease (IBD). A particular subclass, the so‐called ′atypical′ (perinuclear) p‐ANCA type, occurs in the majority of patients with ulcerative colitis. The purpose of this prospective study was to assess, in a blinded fashion, this ′subclinical′ serological marker in a consecutive series of IBD patients. Five hundred patients were evaluated, including 247 patients with ulcerative colitis and 253 with Crohn′s disease involving the small and/or large intestine. Overall, 194 (38.8%) of all patients with IBD were positive, including 164 (66.3%) with ulcerative colitis and 30 (11.9%) with Crohn′s disease. Except for coexistent sclerosing cholangitis, no other clinical or laboratory variable had an effect on the rate of ANCA detection. This is the largest single study of ANCA in patients with IBD and the only study to provide data solely from a single Canadian centre. Results emphasize the immunopathological differences between ulcerative colitis and Crohn′s disease, and indicate that both disorders are heterogeneous inflammatory disease processes.
Evaluation of the Endomysial Antibody for Celiac Disease: Operating Properties and Associated Cost Implications in Clinical Practice
Authors: Atkinson Kenneth , Tokmakajian Sonya , Watson William , Gregor James
Published: March 2016

OBJECTIVE: To evaluate the operating properties of endomysial antibodies (EMAs) in the diagnosis of celiac disease and to examine, using a cost minimization model, different strategies used in the diagnosis of celiac disease.

METHODS: A total of 248 EMA results were reviewed and compared with small bowel biopsy results in 66 patients who had undergone both tests. Regression analysis was used to look for predictors of positive EMA results and positive biopsy results. A cost minimization model from a societal perspective was used to evaluate the cost differences among three different strategies.

RESULTS: EMAs had a sensitivity of 95% and specificity of 64%. The only predictor of a positive biopsy result that reached statistical significance was a positive EMA. The strategy of EMA as a diagnostic test for celiac disease was the most expensive strategy, with a cost of $3,174 per patient assessed. The strategy of small bowel biopsy for all patients had a cost of $997, and a strategy of EMA followed by small bowel biopsy for positive patients had a cost of $866 per patient. The results were sensitive to cost of a gluten‐free diet, the specificity of the EMA and the cost of a small bowel biopsy.

CONCLUSION: The EMA is best used as a screening test from both a clinical and cost perspective.
Pharmacokinetics and Pharmacodynamics during Treatment with the Omeprazole 20 mg Enteric‐Coated Tablet and 20 mg Capsule in Asymptomatic Duodenal Ulcer Patients
Authors: Thomson ABR , Kirdeikis P , Lastiwka R , Rohss K , Sinclair P , Olofsson B
Published: March 2016

This study compared the 24 h intragastric pH profile and bioavailability at repeated dosing conditions of the omeprazole 20 mg enteric‐coated tablet versus the 20 mg capsule. Forty duodenal ulcer patients in asymptomatic remission completed this randomized open two‐way crossover study. Omeprazole 20 mg tablets or capsules were administered for seven days in each period. A 24 h pH recording was performed before the start of treatment and on day 7 of each treatment period. Plasma concentrations of omeprazole were determined 24 h after the dose. The treatment periods were separated by two to four weeks. The difference in percentage of time with pH of at least 3 was less than 16% in favour of the tablet (not significant). The estimated mean area under the plasma concentration‐time curve as well as the maximum plasma concentration (Cmax) for omeprazole were 18% and 41% higher, respectively, for the tablet versus the capsule, with the latter percentage being statistically significant. The time to reach Cmax (tmax) with the tablet was, on average, about 0.5 h longer than to reach the tmax of the capsule. This study indicates that the enteric‐coated tablet formulation of omeprazole is biodynamically equivalent to the capsule regarding their effects on intragastric pH during repeated dosing.
Profile of a Liver Transplant Follow‐Up Clinic in a Nontransplant Canadian Urban Centre
Authors: Bazylewski R , Rosser BG , Cohen A , Kaita KDE , Minuk GY
Published: March 2016

Care of the growing number of liver transplant recipients will increasingly fall on the referring centres. Thus, there is a need to define more clearly the demographic, clinical and laboratory profiles of liver transplant recipients, particularly in the setting of a centre where a liver transplantation program does not exist. The present study documented these features in 37 patients attending an adult ambulatory care clinic in an urban, nonliver transplant centre. Mean ± SD age of the study population was 44±11.9 years. Twenty‐one patients (57%) were male. Annual enrolment in the clinic increased from three patients at the completion of the clinic′s first year (1988) to 16 patients in the final year of the study (1993). Time between the transplantation procedure and the patient′s return to the referring centre decreased from a mean of 12 weeks in 1988 to four weeks in 1993. During those seven years no patient required an unscheduled return to the transplant centre for surgical complications or problems associated with immunosuppressive therapy. In conclusion, these data provide a profile of liver transplant patients attending a nonliver transplant centre for follow‐up and support the concept that nontransplant centres are capable of providing safe and, in terms of travel, less expensive care for liver transplant recipients.
National Survey of Radionuclide Gastric Emptying Studies
Authors: House A , Champion MC , Chamerlain M
Published: March 2016

A survey was mailed to all institutions in Canada licensed to use radiopharmaceuticals. Questions addressed meal type; mode of preparation; and means, ranges and SD of emptying times. Seventy‐eight per cent of 222 facilities responded, including all 55 teaching centres. Eighty‐five per cent of teaching and 56% of nonteaching centres perform solid phase gastric emptying studies (GES). The majority use 99mTc sulphur colloid (Tc‐SC) added to eggs before cooking as the standard meal. Twenty‐five per cent of teaching and 21% of nonteaching centres perform liquid phase GES. Most use a watery solution of 111In‐diethylenetriamine pentaacetic acid. Gastric emptying for solid phase GES, expressed as time for 50% emptying (mean t½), varied from 42 to 105 mins for centres using the Tc‐SC egg meal. Twenty‐eight per cent of teaching centres used ±2 SD to define their normal range, 26% used ±1 SD, 6% used ±1.5 SD, and 40% did not know the number of SD used. Twenty per cent of non‐teaching centres used ±2 SD, 12% used ±1 SD and 68% did not know how many SD were used. For liquid phase GES, mean t½ varied from 20 to 60 mins. Eighteen per cent of centres used healthy volunteers to establish or validate normal ranges. There is substantial variability among the normal ranges for radionuclide solid and liquid phase GES in both teaching and nonteaching centres across Canada. A minority of facilities have established or validated their own normal ranges in healthy volunteers. There is a need for a more standardized protocol and range of normal, with internal validation by each institution.
Canadian Association of Gastroenterology Practice Guideline for Informed Consent – Gastrointestinal Endoscopy
Authors: MacSween H Miller
Published: March 2016

Informed consent has undergone a transformation from an ethical concept to a legal doctrine. It is based on the ethical principles of self-determination and autonomy. Over the past several years, courts have established physician liability based on the failure to obtain adequate informed consent. It is the duty of all gastrointestinal endoscopists to obtain legally adequate informed consent before performing any endoscopic procedure.
Helicobacter pylori in South America
Authors: Castro Luiz de Paula , Coelho Luiz Gonzaga Vaz
Published: March 2016

Helicobacter pylori is the most common chronic bacterial infection in humans. In less developed nations, eg, most South American countries, the prevalence of H pylori infection ranges from 70% to 90% of the population. In these countries there is rapid acquisition of the infection in early life, due to poor sanitation, low standards of living conditions and an increased rate of H pylori infection. The management of H pylori infection in South America is outlined.
Omeprazole for Refractory Gastroesophageal Reflux Disease during Pregnancy and Lactation
Authors: Marshall John K , Thomson Alan BR , Armstrong David
Published: March 2016

Symptomatic gastroesophageal reflux is a common complication of pregnancy and lactation. However, the safety of many effective medical therapies, including oral proton pump inhibitors, has not been well defined. The administration of oral omeprazole to a 41‐year‐old female during the third trimester of pregnancy, after ranitidine and cisapride failed to control her refractory gastroesophageal reflux, is reported. No adverse fetal effects were apparent, and the patient elected to continue omeprazole therapy (20 mg/day) while breastfeeding. Peak omeprazole concentrations in breast milk (58 nM, 3 h after ingestion) were less than 7% of the peak serum concentration (950 nM at 4 h), indicating minimal secretion. Although omeprazole is a potentially useful therapy for refractory gastroesophageal reflux during pregnancy and lactation, further data are needed to define better its safety and efficacy.
Nutrition and Chronic Liver Disease
Authors: Siriboonkoom Wichai , Gramlich Leah
Published: March 2016

Malnutrition frequently occurs in patients with chronic liver disease, and may influence both short and long term clinical outcome in these patients. Therefore, nutritional intervention may play an important role in the management of chronic liver disease patients. Recent progress in nutritional assessment, principles of nutrition management and the impact of malnutrition upon the clinical outcome of chronic liver disease are reviewed and summarized. Recommendations on how to manage/prevent malnutrition in these patients will be presented.
Churg‐Strauss Syndrome Leading to Small Bowel Infarction: An Unusual Case of Abdominal Pain in a Young Patient
Authors: Sookram Sunil , Hancock-Friesen Camille , Ferguson JP , Sosnowski Terry , Russell Laurie JM
Published: March 2016

A 33‐year‐old man with a history of severe asthma presented to the emergency department with a week‐long history of severe unrelenting abdominal pain, nausea and decreased appetite. He was admitted to hospital, and routine gastrointestinal investigations were performed, which did not elucidate the cause of his abdominal pain. Exploratory laparotomy demonstrated patchy infarction of the entire small bowel, characteristic of Churg‐Strauss syndrome. The patient subsequently underwent 12 separate laparotomies to salvage surviving small bowel. The patient is maintained on total parenteral nutrition.
Correcting Reflux Laparoscopically
Authors: Poulin Eric C , Schlachta Christopher M , Mamazza Joseph
Published: March 2016

Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen) because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.
Selecting Candidates for Liver Transplantation: A Medical Ethics Perspective on the Microallocation of a Scarce and Rationed Resource
Authors: Yoshida Eric M
Published: March 2016

Liver transplantation has evolved over the past 35 years from an experimental procedure with high perioperative mortality to an accepted form of treatment with an approximate 85% one‐year and 80% three‐year patient survival rate. Following the success and acceptance of transplantation in the treatment of end‐stage liver disease, there has been a progressive increase in the number of patients seeking a limited supply of donor organs. The ethical focus, on a microallocation level, has therefore changed from that of the 1960s, when the question was whether the procedure should be offered at all, to that of the 1990s and beyond, when the focus is on the proper allocation of a scarce, life‐saving resource. The ethical issues concerning fair allocation surrounding liver transplantation are explored, from both the referring physician′s perspective and the perspective of the transplant physician. In particular, the contrasting viewpoints of bioethicists Nicholas Rescher and James Childress, with respect to nonmedical and social criteria in the selection of patients for scarce, life‐saving therapies, are explored. Lastly, some alternative ethical models for patient selection are reviewed.
Altered Colonic Environment, a Possible Predisposition to Colorectal Cancer and Colonic Inflammatory Bowel Disease: Rationale of Dietary Manipulation with Emphasis on Disaccharides
Authors: Szilagyi A
Published: March 2016

A recurrent theme in the schema of pathogenetic mechanisms attributed to colorectal cancer (CRC) and inflammatory bowel disease (IBD) is the interaction between genes and environment. Dietary and other environmental factors, and lower intestinal flora and their chemical interactions occur in the pathogenesis of both. Events at the mucosal surface may be influenced by factors in the luminal environment and by contributions of the host. In addition, both forms of IBD ‐ Crohn′s disease (CD) and ulcerative colitis (UC) ‐ have distinctive associated host events. Even within CD and UC, different clinical patterns and prognoses may have different specific host mechanisms. Some of the current putative pathogenetic processes in CRC and IBD are reviewed. Particular attention is given to hypotheses relating to the role of dietetic substances, mainly fibre and dairy products, and how they may affect disease formation. It is argued that within the context of hypotheses proposed for possible beneficial effects of these two dietetic factors, CRC and IBD may be considered together. Further support is lent to arguments that similar and additional hypothetical features ascribed to beneficial effects of fibre may be attributed to disaccharides, lactose and its derivatives, lactulose and lactitol.
Obscure Gastrointestinal Bleeding from an Ampullary Tumour in a Patient with a Remote History of Renal Cell Carcinoma: A Diagnostic Conundrum
Authors: Janzen Rhonda M , Ramj Alnoor S , Flint Julia DA , Scudamore Charles H , Yoshida Eric M
Published: March 2016

Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.
Electrogastrography: A Noninvasive Technique to Evaluate Gastric Electrical Activity
Authors: Sanmiguel Claudia P , Mintchev Martin P , Bowes Kenneth L
Published: March 2016

Electrogastrography (EGG) is the recording of gastric electrical activity (GEA) from the body surface. The cutaneous signal is low in amplitude and consequently must be amplified considerably. The resultant signal is heavily contaminated with noise, and visual analysis alone of an EGG signal is inadequate. Consequently, EGG recordings require special methodology for acquisition, processing and analysis. Essential components of this methodology involve an adequate system of digital filtering, amplification and analysis, along with minimization of the sources of external noise (random motions of the patient, electrode-skin interface impedance, electrode bending, obesity, etc) and a quantitative interpretation of the recordings. There is a close relationship between GEA and gastric motility. Although it has been demonstrated that EGG satisfactorily reflects internal GEA frequency, there is not acceptable correlation with gastric contractions or gastric emptying. Many attempts have been made to relate EGG 'abnormalities' with clinical syndromes and diseases; however, the diagnostic and clinical value of EGG is still very much in question.
Hemorrhagic Intestinal Henoch-Schonlein Purpura Complicated by Cytomegalovirus Infection
Authors: Nguyen-Ho Phong , Jewell Laurence D , Thomson Alan BR
Published: March 2016

A 54-year-old man on hemodialysis for acute chronic renal failure and on corticosteroids for Henoch-Schonlein purpura developed massive hematochezia. After extensive clinical investigation, an ileal bleeding site was identified and surgically removed. Pathological examination of the diseased bowel segment revealed an extensive vasculitis with mucosal ulceration attributable to Henoch-Schonlein purpura as well as florid cytomegalovirus infection.
Anti-Thyroid Peroxidase Antibodies and Male Gender Are Associated with Diabetes Occurrence in Patients with Beta-Thalassemia Major
Authors: Pes Giovanni M. , Tolu Francesco , Dore Maria P.
Published: March 2016

Background. Intensive transfusion schedule and iron-chelating therapy prolonged and improved quality of life in patients withβ-thalassemia (β-T) major. However, this led to an increased risk of developing impaired glucose tolerance or diabetes. In this study we analyzed variables associated with the occurrence of impaired glucose tolerance or diabetes in patients withβ-T major.Methods. 388 Sardinian patients were included. Age, gender, duration of chelation therapy, body mass index, and markers of pancreatic and extrapancreatic autoimmunity were analyzed.Results. Multiple logistic regression analysis showed that anti-thyroid peroxidase (TPO) antibodies (Ab) (OR = 3.36;p=0.008) and male gender (OR = 1.98;p=0.025) were significantly associated with glucose impairment, while the other variables were not. Ferritin levels were significantly higher in TPOAb positive compared to TPOAb negative patients (4870 ± 1665μg/L versus 2922 ± 2773μg/L;p<0.0001).Conclusions. In patients withβ-T major a progressive damage of insulin-producing cells due to secondary hemosiderosis appears to be the most reasonable mechanism associated with glucose metabolism disorders. The findings need to be confirmed with additional well designed studies to address the question of whether TPOAb may have a role in the management of these patients.
Possibilities for Advanced Encoding Techniques at Signal Transmission in the Optical Transmission Medium
Authors: Čertík Filip , Róka Rastislav
Published: March 2016

This paper presents a possible simulation of negative effects in the optical transmission medium and an analysis for the utilization of different signal processing techniques at the optical signal transmission. An attention is focused on the high data rate signal transmission in the optical fiber influenced by linear and nonlinear environmental effects presented by the prepared simulation model. The analysis includes possible utilization of OOK, BPSK, DBPSK, BFSK, QPSK, DQPSK, 8PSK, and 16QAM modulation techniques together with RS, BCH, and LDPC encoding techniques for the signal transmission in the optical fiber. Moreover, the prepared simulation model is compared with real optical transmission systems. In the final part, a comparison of the selected modulation techniques with different encoding techniques and their implementation in real transmission systems is shown.
Safety Evaluation of Unani Formulation: Capsule Shaqeeqa in Albino Wistar Rats
Authors: Ghazanfar Khalid , Ahmad Dar Showkat , Akbar Seema , Nazir Tazeen , Hamdani Mariya , Siddiqui Khalid M. , Kumar Pawan , Masood Akbar
Published: March 2016

Capsule Shaqeeqa, Unani formulation, is prescribed for the clinical treatment of diseases like sinusitis, headache, and migraine. The safety evaluation data of it is not available; in order to provide the safety data the present study was carried out. The study was carried out on four groups of rats (n=5). Two groups (one male and one female group) as normal controls were orally given water while the other two groups were orally given daily doses of drug at the dose level of 150 mg/kg of body weight for duration of 90 days. Physiological parameters like body weight, feed consumption, water consumption, and clinical signs were regularly monitored and recorded. Organs were collected, examined, and weighed and specimens were taken for histopathological studies. The results showed that the drug did not alter the physiological parameters. There was no mortality or any morbidity found in drug treated rats. There was no statistical significant change found in any haematological or biochemical parameter of rats orally fed with Shaqeeqa. A statistically insignificant association verified that haematological and biochemical parameters were rendered unaffected by the drug. Moreover histological investigations of essential key organs demonstrated that the drug did not prompt any histopathological change. These observations demonstrate the safety of Capsule Shaqeeqa at the studied dosage levels.
A Successful Mother and Neonate Outcome for a Woman with Essential Thrombocytosis and FV Leiden Heterozygosity
Authors: Politou Marianna , Valsami Serena , Gkorezi-Ntavela Irontianta , Telonis Vasilios , Merkouri Efrosyni , Christopoulos Panagiotis
Published: March 2016

Essential thrombocytosis (ET) and FV Leiden heterozygosity represent an acquired and hereditable hypercoagulable state, respectively. An uncommon case of coexistence of ET and FV Leiden heterozygosity in a 36-year-old pregnant woman and her successful pregnancy outcome is described. She was considered to be at high risk of thrombosis during her pregnancy and she was treated with both prophylactic dose of LMWH and aspirin daily throughout her pregnancy and for a 6-week period postpartum. The efficacy of the anticoagulation treatment was monitored in various time points not only by measuring anti-Xa levels and D-Dimers but also with new coagulation methods such as rotation thromboelastometry and multiplate. Global assessment of coagulation using additional newer laboratory tests might prove useful in monitoring coagulation pregnancies at high risk for thrombosis.
Applicability of Pulse Pressure Variation during Unstable Hemodynamic Events in the Intensive Care Unit: A Five-Day Prospective Multicenter Study
Authors: Delannoy Bertrand , Wallet Florent , Maucort-Boulch Delphine , Page Mathieu , Kaaki Mahmoud , Schoeffler Mathieu , Alexander Brenton , Desebbe Olivier
Published: March 2016

Pulse pressure variation can predict fluid responsiveness in strict applicability conditions. The purpose of this study was to describe the clinical applicability of pulse pressure variation during episodes of patient hemodynamic instability in the intensive care unit. We conducted a five-day, seven-center prospective study that included patients presenting with an unstable hemodynamic event. The six predefined inclusion criteria for pulse pressure variation applicability were as follows: mechanical ventilation, tidal volume >7 mL/kg, sinus rhythm, no spontaneous breath, heart rate/respiratory rate ratio >3.6, absence of right ventricular dysfunction, or severe valvulopathy. Seventy-three patients presented at least one unstable hemodynamic event, with a total of 163 unstable hemodynamic events. The six predefined criteria for the applicability of pulse pressure variation were completely present in only 7% of these. This data indicates that PPV should only be used alongside a strong understanding of the relevant physiology and applicability criteria. Although these exclusion criteria appear to be profound, they likely represent an absolute contraindication of use for only a minority of critical care patients.
Cell Type-Specific Effects of Mutant DISC1: A Proteomics Study
Authors: Xia Meng , Broek Jantine A.C. , Jouroukhin Yan , Schoenfelder Jeannine , Abazyan Sofya , Jaaro-Peled Hanna , Sawa Akira , Bahn Sabine , Pletnikov Mikhail
Published: March 2016

Despite the recent progress in psychiatric genetics, very few studies have focused on genetic risk factors in glial cells that, compared to neurons, can manifest different molecular pathologies underlying psychiatric disorders. In order to address this issue, we studied the effects of mutant disrupted in schizophrenia 1 (DISC1), a genetic risk factor for schizophrenia, in cultured primary neurons and astrocytes using an unbiased mass spectrometry-based proteomic approach. We found that selective expression of mutant DISC1 in neurons affects a wide variety of proteins predominantly involved in neuronal development (e.g., SOX1) and vesicular transport (Rab proteins), whereas selective expression of mutant DISC1 in astrocytes produces changes in the levels of mitochondrial (GDPM), nuclear (TMM43) and cell adhesion (ECM2) proteins. The present study demonstrates that DISC1 variants can perturb distinct molecular pathways in a cell type-specific fashion to contribute to psychiatric disorders through heterogenic effects in diverse brain cells.
Stewart-Treves Syndrome: A Case Report and Review of the Literature
Authors: Berebichez-Fridman Roberto , Deutsch Yehuda E. , Joyal Thomas M. , Montero Olvera Pablo , Benedetto Pasquale W. , Rosenberg Andrew E. , Kett Daniel H.
Published: March 2016

The Stewart-Treves syndrome is a rare and deadly entity, which is defined as angiosarcoma arising in the setting of chronic lymphedema. It typically presents in women who develop lymphedema in the upper extremity secondary to axillary lymph node dissection for breast cancer surgery. It is extremely uncommon in the lower extremities as a result of idiopathic chronic lymphedema. Here, we present the case of a 63-year-old female patient with idiopathic chronic lymphedema of the lower extremities having morbid obesity (BMI 82.6) and multiple comorbidities. She developed multiple confluent, hemorrhagic and necrotic elevated purple-black papules in the lower extremities, for which the initial diagnosis was cellulitis. Because there was no improvement with antibiotics, a lower extremity ultrasound and biopsy was performed which showed multiple masses in the left inner upper calf with solid and cystic components. The pathology results of the punch biopsies were consistent with angiosarcoma. Immunohistochemical studies revealed positivity for CD31, FLI-1, and a high Ki-67 proliferation rate. Because of the patient's weight and medical comorbidities, no further extensive diagnostic tests were performed to detect metastatic disease, and because of contraindications, no further medical treatment was provided. The patient subsequently died 1 month after diagnosis.
Key Software Metrics and its Impact on each other for Software Development Projects
Authors: Bhardwaj Mridul , Rana Ajay
Published: March 2016

Every software development project is unique and different from repeatable manufacturing process. Each software project share different challenges related to technology, people and timelines. If every project is unique, how project manager can estimate project in a consistent way by applying his past experience. One of the major challenges faced by the project manager is to identify the key software metrics to control and monitor the project execution. Each software development project may be unique but share some common metric that can be used to control and monitor the project execution. These metrics are software size, effort, project duration and productivity. These metrics tells project manager about what to deliver (size), how it was delivered in past (productivity) and how long will it take to deliver with current team capability (time and effort). In this paper, we explain the relationship among these key metrics and how they statistically impact each other. These relationships have been derived based on the data published in book “Practical Software Estimation” by International Software Benchmarking Group. This paper also explains how these metrics can be used in predicting the total number of defects. Study suggests that out of the four key software metrics software size significantly impact the other three metrics (project effort, duration and productivity). Productivity does not significantly depend on the software size but it represents the nonlinear relationship with software size and maximum team size, hence, it is recommended not to have a very big team size as it might impact the overall productivity. Total project duration only depends on the software size and it does not depend on the maximum team size. It implies that we cannot reduce project duration by increasing the team size. This fact is contrary to the perception that we can reduce the project duration by increasing the project team size. We can conclude that software size is the important metrics and a significant effort must be put during project initiation phases to estimate the project size. As software size will help in estimating the project duration and project efforts so error in estimating the software size will have significant impact on the accuracy of project duration and effort. All these key metrics must be re-calibrated during the project development life cycle.

 