bluuebunny/crossref_metadata_2025 huggingface dataset:
Empirical rescue therapy after Helicobacter pylori treatment failure: a 10‐year single‐centre study of 500 patients
Authors: GISBERT J. P. , GISBERT J.‐L. , MARCOS S. , JIMENEZ‐ALONSO I. , MORENO‐OTERO R. , PAJARES J. M.
Published: July 2010

Background  Several ‘rescue’ therapies have been recommended to eradicate Helicobacter pylori, but they still fail in >20% of the cases, and these patients constitute a therapeutic dilemma.

Aim  To evaluate the efficacy of different ‘rescue’ therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection.

Methods 
Design
: Prospective single‐centre study. Patients: Consecutive patients in whom at least one eradication regimen had failed. Intervention: Rescue regimens included: (i) quadruple therapy with omeprazole–bismuth–tetracycline–metronidazole; (ii) ranitidine bismuth citrate–tetracycline–metronidazole; (iii) omeprazole–amoxicillin–levofloxacin; and (iv) omeprazole–amoxicillin‐rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically). Outcome: Eradication was defined as a negative 13C‐urea breath test 4–8 weeks after completing therapy.

Results  Five hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance rates with first‐, second‐ and third‐line regimens were 92%, 92%, and 95%, respectively. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second‐, third‐, and fourth‐line regimens. Overall, H. pylori cure rates with the second‐, third‐, and fourth‐line rescue regimens were 70%, 74%, and 76%, respectively. Cumulative H. pylori eradication rate with four successive treatments was 99.5%.

Conclusion  It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.
Systematic review: nutritional therapy in paediatric Crohn’s disease
Authors: DAY A. S. , WHITTEN K. E. , SIDLER M. , LEMBERG D. A.
Published: July 2010

Background At least 25% of individuals diagnosed with Crohn’s disease (CD) have onset of disease in childhood. Almost all children with CD have nutritional impairments, such as weight loss or stunting, at diagnosis or subsequently. Nutritional therapy (exclusive enteral nutrition) is established as a valid and effective treatment in paediatric CD. The advantages of this approach are induction of remission and control of inflammatory changes, mucosal healing, positive benefits to growth and overall nutritional status, and avoidance of other medical therapies.

Aim To provide a comprehensive up‐to‐date review of the roles of nutritional therapy in CD and of the data supporting this therapy.

Methods A search of PubMed was performed with search terms ‘enteral nutrition’, ‘nutritional therapy’, ‘Crohn disease’ and ‘children’. Relevant articles were selected from this search. In addition, the reference lists of available articles were reviewed for further relevant articles.

Results Nutritional therapy offers numerous benefits in the management of CD. Recent work has begun to elucidate the likely mechanisms of this therapy. These include direct mucosal anti‐inflammatory effects and alteration of intestinal microflora.

Conclusion Further studies are required to define longer‐term effects of nutritional therapy in patients with CD.
Effect of proton pump inhibitors on markers of risk for high‐grade dysplasia and oesophageal cancer in Barrett’s oesophagus
Authors: HILLMAN L. C. , CHIRAGAKIS L. , SHADBOLT B. , KAYE G. L. , CLARKE A. C.
Published: July 2010

Background  It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high‐risk group for Barrett’s oesophagus.

Aim  To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett’s oesophagus influences markers for risk development of subsequent high‐grade dysplasia/adenocarcinoma.

Methods  A review of all patients with Barrett’s oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett’s oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low‐grade dysplasia. Subsequent development of high‐grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low‐grade dysplasia at entry was determined.

Results  Fourteen patients developed high‐grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98–5.85) more likely to have a macroscopic marker or low‐grade dysplasia than those patients already on a proton pump inhibitor.

Conclusions  Use of proton pump inhibitor therapy prior to diagnosis of Barrett’s oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett’s oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.
Mortality rates in patients with Barrett’s oesophagus
Authors: MOAYYEDI P. , BURCH N. , AKHTAR‐DANESH N. , ENAGANTI S. K. , HARRISON R. , TALLEY N. J. , JANKOWSKI J.
Published: July 2010

Background  Patients with Barrett’s oesophagus are at increased risk of oesophageal adenocarcinoma. Observational studies have suggested increase in overall mortality also but data are conflicting.

Aim  To assess the cause of death in patients with Barrett’s oesophagus compared with the general population.

Methods  Patients with Barrett’s oesophagus were identified retrospectively in four hospitals in Leicestershire, UK using electronic endoscopy and histopathology records from 1997 to 2003. Data on deaths from this cohort of patients were identified through the Office of National Statistics and compared with age– and gender‐adjusted mortality in the Leicestershire region.

Results  In all, 1272 Barrett’s patients were identified with 245 deaths in this cohort. Overall mortality was found to be increased [male standardized mortality ratio (SMR) = 552, 95% CI = 466–638; female SMR 455, 95% CI = 357–552]. The main disease areas that were responsible for this increase were oesophageal adenocarcinoma (n = 25, male SMR = 2171, 95% CI = 991–3351; female SMR = 1300, 95% CI = 26–2574), bronchopneumonia (n = 70, male SMR = 146, 95% CI = 55–236; female SMR = 436, 95% CI = 272–601) and ischaemic heart disease (n = 51, male SMR = 186, 95% CI = 97–2748; female SMR = 205, 95% CI = 105–306).

Conclusions  Patients with Barrett’s oesophagus die more commonly of bronchopneumonia and ischaemic heart disease compared with oesophageal adenocarcinoma, and overall mortality in this group may be increased.
Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis
Authors: GÓMEZ‐DOMINGUEZ E. , MENDOZA J. , GARCÍA‐BUEY L. , TRAPERO M. , GISBERT J. P. , JONES E. A. , MORENO‐OTERO R.
Published: July 2010

Background  Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease.

Aim  To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements.

Methods  Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis.

Results  Of the 80 patients included, 91, 4% were women and their mean age was 56 ± 12 (s.d.) years. A significant correlation was found (P < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F > 2 and 0.96 for F = 4. Liver stiffness measurements were 9.0 ± 5.3 and 7.9 ± 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively (P > 0.05).

Conclusions  In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.
Peginterferon alfa‐2a/ribavirin in hepatitis C virus patients nontolerant or nonresponsive to peginterferon alfa‐2b/ribavirin
Authors: RUSTGI V. K. , ESPOSITO S. , HAMZEH F. M. , SHIFFMAN M. L.
Published: July 2010

Background  Peginterferon alfa‐2a/ribavirin treatment resulted in fewer incidences of depression and flu‐like symptoms than that of standard interferon/ribavirin, whereas peginterferon alfa‐2b/ribavirin and standard interferon/ribavirin treatment resulted in similar incidences of these adverse events (AEs).

Aim  To assess the efficacy and safety of peginterferon alfa‐2a/ribavirin in genotype 1‐infected patients treated for up to 12 weeks with peginterferon alfa‐2b/ribavirin but not achieving early virologic response (EVR) (non‐EVR) or nontolerant (NT) because of depression, fatigue, flu‐like symptoms, or injection‐site reactions.

Methods  Nontolerants were treated for an additional 36 weeks and non‐EVRs for an additional 60 weeks with peginterferon alfa‐2a (180 μg/week)/ribavirin (1000/1200 mg/day). Patients with detectable HCV RNA after 12 weeks were discontinued.

Results  Of 25 NTs, 23 (92%) were HCV‐RNA negative after 12 weeks on peginterferon alfa‐2a/ribavirin and 14 (56%) achieved sustained virologic response. Of 32 non‐EVRs to peginterferon alfa‐2b/ribavirin, four (13%) achieved EVR with peginterferon alfa‐2a/ribavirin and one (3%) achieved sustained virologic response. Four non‐EVRs and 0 NTs were withdrawn for AEs; 26 (81%) and 24 (96%), respectively, completed peginterferon alfa‐2a/ribavirin treatment or were withdrawn for insufficient response at week 12. In NTs, depression, fatigue, flu‐like symptoms, and injection‐site reactions declined during treatment.

Conclusion  Most patients who did not tolerate peginterferon alfa‐2b/ribavirin because of AEs, and who completed the full 36‐week course of peginterferon alfa‐2a/ribavirin treatment, achieved sustained virologic response.
Clinical trial: interferon alpha‐2b continuous long‐term therapy vs. repeated 24‐week cycles for re‐treating chronic hepatitis C
Authors: MCHUTCHISON J. G. , PATEL K. , SCHIFF E. R. , GITLIN N. , MUR R. E. , EVERSON G. T. , CARITHERS R. L. , DAVIS G. L. , MARCELLIN P. , SHIFFMAN M. L. , HARVEY J. , ALBRECHT J. K. ,   FOR THE INTERNATIONAL HEPATITIS INTERVENTIONAL THERAPY GROUP
Published: July 2010

Background  Treatment options are limited for patients with hepatitis C virus who do not experience sustained viral eradication with pegylated interferon and ribavirin therapy.

Aim  To compare, in an open‐label, randomized study, long‐term continuous interferon alpha‐2b treatment with repeated 24‐week courses in patients with chronic hepatitis C virus that relapsed after prior interferon monotherapy.

Methods  A total of 499 patients received 24 weeks of interferon alpha‐2b, 3 MIU administered 3 TIW. Responders (normal alanine aminotransferase and negative hepatitis C virus ‐RNA, n = 244) were then randomized to continuous interferon therapy (1, 2 or 3 MIU TIW depending on response) or cyclical therapy (3 MIU TIW for 24 weeks per relapse). Mean Knodell inflammation (I + II + III) and necrosis (IV) scores at baseline vs. year 2 were compared.

Results  Patients receiving continuous low‐dose therapy vs. cycled therapy had larger reductions in inflammation (−3.9 vs. −3.1) and fibrosis (−0.49 vs. −0.24). Among both groups, the mean change was −3.4 for inflammation and −0.36 for fibrosis. Overall, 73% (95% CI: 67–79) of patients experienced reduced inflammation and 28% (95% CI: 22–34) had reduced fibrosis.

Conclusions  Our results suggest hepatitis C virus patients experiencing viral suppression during long‐term maintenance therapy with interferon demonstrate histological improvement. Further prospective trials testing this hypothesis are in progress.
Review article: what do patients with inflammatory bowel disease want for their clinical management?
Authors: WESTWOOD N. , TRAVIS S. P. L.
Published: July 2010

Background  The patient’s perceptions of benefits and risks of treatment differ from those of physicians, yet this topic is rarely explored in ulcerative colitis or Crohn’s disease.

Aim  To present a patient’s perspective on care for their colitis, to consider how patients’ views will influence preliminary proposals for standards of care, and to discuss the different priorities of patients and physicians.

Methods  Description of an individual patient’s journey from diagnosis of ulcerative colitis to colectomy, compared with priorities proposed by a patient‐based organization (National Association of Colitis and Crohn’s disease).

Results  Awareness of colitis in primary care, prompt referral, timely investigation and specialist care if admitted to hospital are shared goals of patients and physicians. Patients are generally prepared to accept higher risks from medical treatment to avoid their undesirable outcomes (especially colectomy) than physicians will on their behalf. There has been little systematic study of this disparity in ulcerative colitis. Under‐reporting the symptom burden, tolerance of treatment side effects, substantial lifestyle changes and willingness to explore any treatment options are characteristic coping strategies. Physicians should be alert to coping strategies, with a willingness to seek second opinions.

Conclusion  Perceptions of risk and benefit differ between patients and physicians, and recognition of this difference is a starting point for difficult clinical decision‐making.
Endoscopic feeding tube placement in patients with cancer: a prospective clinical audit of 2055 procedures in 1866 patients
Authors: SHASTRI Y. M. , SHIRODKAR M. , MALLATH M. K.
Published: July 2010

Background  Feeding tube placement in patients with aero‐digestive cancer is challenging because of the distortion and/or obstruction of the upper digestive passage. As a result, many patients may receive intravenous fluids and parenteral nutrition instead of enteral feeds.

Aim  To audit all the endoscopic feeding tube placements in large sample of patients to determine difficulties, success, reasons for failures and procedure‐related complications.

Methods  Audit of all consecutive feeding tube placements from January 1996 to December 2003 was conducted. Tubes were placed depending on the site of cancer and anticipated duration of feeding: naso‐gastric tubes, naso‐enteral tubes and percutaneous endoscopic gastrostomy. Nutrition support team evaluated these patients. Technical modifications, difficulties, success and complications encountered during the procedure were recorded.

Results  Two thousand and fifty‐five attempts were made for feeding tube placements (naso‐gastric tube – 1637, naso‐enteral tube – 177 and percutaneous endoscopic gastrostomy – 241) in 1866 patients. Technical success was achieved in 1969 (96%, 95% CI: 95–97%). Immediate complications occurred in 62 (3%, 95% CI: 2–4%), seven needed hospitalization and one patient died of tumour perforation caused by naso‐gastric tube placement. The technical success and complications rates of the procedures performed by fellows in training were comparable to those performed by attending consultants.

Conclusions  Enteral feeding tubes can be placed in almost all patients with cancer using endoscopic techniques. Adequate training of the endoscopy fellows and sufficient care by nutrition support team help achieve high success with few complications.
Correlation between symptoms developed after the oral ingestion of 50 g lactose and results of hydrogen breath testing for lactose intolerance
Authors: BEYERLEIN L. , POHL D. , DELCO F. , STUTZ B. , FRIED M. , TUTUIAN R.
Published: July 2010

Background  Lactase deficiency is a common condition responsible for various abdominal symptoms. Lactose hydrogen breath test is currently the gold standard in diagnosing lactose intolerance.

Aim  To assess sensitivity and specificity of symptoms developed after oral lactose challenge.

Methods  Intensity of nausea, abdominal pain, borborygmi, bloating and diarrhoea was recorded every 15 min up to 3 h after ingestion of 50 g lactose in patients with positive (i.e. breath H2‐concentration ≥20 p.p.m. above baseline) and negative lactose hydrogen breath test.

Results  Between July 1999 and December 2005, 1127 patients (72% females) underwent lactose hydrogen breath test. A positive result was found in 376 (33%). Sensitivity of individual symptoms ranged from 39% (diarrhoea) to 70% (bloating) while specificity ranged from 69% (bloating) to 90% (diarrhoea). A positive lactose hydrogen breath test was found in 21% of patients with one symptom, 40% of patients with two symptoms, 44% of patients with three symptoms, 67% of patients with four symptoms and 82% of patients with five symptoms.

Symptom intensity was significantly higher for each symptom in the positive group.

Conclusion  Evaluating symptoms developed after ingestion of 50 g lactose can be used as a simple screening test to select patients who need to be referred for lactose intolerance testing.
Clinical trial: the effect of amitriptyline in patients with diarrhoea‐predominant irritable bowel syndrome
Authors: VAHEDI H. , MERAT S. , MOMTAHEN S. , KAZZAZI A. S. , GHAFFARI N. , OLFATI G. , MALEKZADEH R.
Published: July 2010

Background  Irritable bowel syndrome is the most common disorder diagnosed by gastroenterologists. Although several randomized‐controlled trials have assessed the therapeutic role of antidepressant drugs, there is insufficient evidence to support their use.

Aim  To compare the effects of low‐dose amitriptyline in the treatment of diarrhoea‐predominant irritable bowel syndrome in a double‐blind randomized‐controlled trial.

Methods  Fifty‐four patients who fulfilled Rome II criteria for diarrhoea‐predominant irritable bowel syndrome were included in this study. Organic causes were ruled out by standard laboratory and radiological tests, and rectosigmoidoscopy. Patients were randomly assigned to receive either 10 mg amitriptyline daily or placebo. Subjects were followed up for 2 months and symptoms were assessed using a questionnaire. Intention‐to‐treat and per‐protocol analysis was performed.

Results  Fifty patients completed the study. At 2 months, the amitriptyline group showed greater (P < 0.05) reduction in the incidence of loose stool and feeling of incomplete defecation. Patients receiving amitriptyline showed greater complete response, defined as loss of all symptoms, compared with those receiving placebo (68% vs. 28%, P = 0.01). Adverse effects were similar between the two groups.

Conclusion  Amitriptyline may be effective in the treatment of diarrhoea‐predominant irritable bowel syndrome and at low dose is well tolerated.
Review article: RNA interference – potential therapeutic applications for the gastroenterologist
Authors: PELLISH R. S. , NASIR A. , RAMRATNAM B. , MOSS S. F.
Published: July 2010

Background  A new technique of gene regulation, termed RNA interference, has emerged recently. RNA interference utilizes short double‐stranded RNA to inhibit selectively gene expression of complementary RNA nucleotide sequences after transcription, but prior to translation. Gastrointestinal and hepatic disorders may be particularly amenable to therapeutic RNA interference intervention because of the relative ease of delivery of drugs to the gastrointestinal tract and liver.

Aim  To examine the published literature for potential clinical uses of RNA interference in gastroenterology and speculate on future therapies for luminal disease.

Methods  Reports were identified using PubMed and the search term ‘RNA interference’, focusing on therapeutic uses related to gastrointestinal and liver disease.

Results  Cellular and animal models demonstrate the potential application of short‐interfering RNA‐based therapies for viral hepatitis and inflammatory bowel disease. With validation of specific targets and better in vivo delivery of short‐interfering RNA, RNA interference may represent a new frontier for molecular‐targeted therapy in gastroenterology and hepatology.

Conclusions  Short‐interfering RNA provides a novel and specific means to inhibit gene expression. Translation to the clinical arena will require further definition of side‐effects, off‐target effects and delivery systems. Ultimately, mucosally applied or endoscopically delivered short‐interfering RNA could be one of the earliest clinical uses of short‐interfering RNA therapy.
Review article: psychological aspects of home parenteral nutrition, abnormal illness behaviour and risk of self‐harm in patients with central venous catheters
Authors: STERN J. M. , JACYNA N. , LLOYD D. A. J.
Published: July 2010

Background  Home parenteral nutrition is established as standard management for patients with chronic severe intestinal failure. Although the treatment is welcomed by many patients, there are psychological consequences of living with a central venous catheter and there are associated restrictions to the lives of patients on home parenteral nutrition. A subgroup of home parenteral nutrition patients may use their central venous catheter for self‐harm.

Aims  To review existing literature relating to abnormal psychological responses to central venous catheters in patients receiving home parenteral nutrition and the psychological meaning of living with a central venous catheter. It also attempts to alert professionals to ways in which patients may self‐harm using their central venous catheters.

Methods  A literature review was performed. Data were obtained both from literature searches and from personal experience at a Psychological Medicine Unit attached to a large home parenteral nutrition centre.

Results  Patients receiving home parenteral nutrition may use their central venous catheter in various ways to self‐harm. Motivation may be conscious or unconscious. Sequelae of such self‐harm may be life‐threatening.

Conclusion  This paper concludes with recommendations for best practice with respect to the psychological management of home parenteral nutrition patients in whom central venous catheter abuse is suspected.
Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia
Authors: KATAGIRI A. , FU K.‐I. , SANO Y. , IKEMATSU H. , HORIMATSU T. , KANEKO K. , MUTO M. , YOSHIDA S.
Published: July 2010

Background  The presence of abnormal microcapillaries detected by narrow band imaging (NBI) with magnifying colonoscopy has been reported to be a marker of colorectal neoplasia.

Aim  To investigate prospectively if NBI with magnification could help predict the histology of early colorectal neoplasia.

Methods  A series of 104 consecutive patients with 139 colorectal lesions were studied. All lesions were detected by conventional colonoscopy and subsequently evaluated by NBI with magnification. During NBI with magnification, the microvascular architecture observed on the surface of the detected lesions, capillary patterns (CP), was divided into non‐neoplastic (CP I) and neoplastic (CP II and CP III) types. Only lesions endoscopically diagnosed as CP II or CP III were included in the study. All of the lesions were resected endoscopically or surgically and examined histologically for comparison.

Results Ninety‐seven per cent (n = 103) of colorectal neoplastic lesions with CP II were histologically diagnosed as low‐grade dysplasia. Eighty‐seven per cent (n = 31) of the colorectal neoplastic lesions with CP III were high‐grade dysplasia or invasive cancer.

Conclusion  Capillary patterns observed by NBI with magnification could be used to assess the degree of atypia in early colorectal neoplasia.
Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten‐sensitive enteropathy
Authors: SANTAOLALLA R. , FERNÁNDEZ‐BAÑARES F. , RODRÍGUEZ R. , ALSINA M. , ROSINACH M. , MARINÉ M. , FARRÉ C. , SALAS A. , FORNÉ M. , LORAS C. , ESPINÓS J. , VIVER J. M. , ESTEVE M.
Published: July 2010

Background  In gluten‐sensitive enteropathy, antitissue transglutaminase antibodies are synthesized in the duodenum.

Aim  To compare the diagnostic yield of these autoantibodies in cultured duodenal biopsies, duodenal aspirate and serum.

Methods  Patients (n = 315, 135 female, 180 male; age: 37.3 ± 1.1 years) referred for duodenal biopsies, were recruited and HLA‐DQ2/DQ8 haplotyped. Histological measurements were made from duodenal biopsies and cultured duodenal biopsies were used for antitissue transglutaminase antibodies analysis by enzyme‐linked immunosorbent assay. Duodenal aspirate was collected in a subgroup of 81 patients. Patients were classified, according to their histology, response to a gluten‐free diet and DQ2/DQ8 status, as definite, likely or nongluten‐sensitive enteropathy.

Results  Histology was normal in 59% of patients; 28% had lymphocytic enteritis, 1% had crypt hyperplasia and 13% showed atrophy. In Marsh III patients, there was complete agreement between duodenal and serological antitissue transglutaminase antibodies measurements. Marsh I patients showed a slight antitissue transglutaminase antibodies sensitivity improvement in cultured duodenal biopsy compared to serum in definite (22% vs. 19%) and likely gluten‐sensitive enteropathy (20% vs. 14%) patients. Combined serum and cultured duodenal biopsy antitissue transglutaminase antibodies assessment increased serological sensitivity from 19% to 30% in Marsh I patients.

Conclusion  Duodenal antitissue transglutaminase antibodies detection improves serological determination sensitivity in Marsh I patients, providing diagnostic value and therapeutic impact.
Histological subclassification of cirrhosis based on histological–haemodynamic correlation
Authors: KUMAR M. , SAKHUJA P. , KUMAR A. , MANGLIK N. , CHOUDHURY A. , HISSAR S. , RASTOGI A. , SARIN S. K.
Published: July 2010

Background  Determining a relationship between specific histological parameters in cirrhosis and hepatic venous pressure gradient can be used to subclassify cirrhosis.

Aim  To determine the relationship between hepatic venous pressure gradient and specific histological parameters in cirrhosis.

Methods  Forty‐seven patients (mean age: 46.2 ± 13.6 years; 36 male) with biopsy‐proven cirrhosis and hepatic venous pressure gradient measurements within 1 month of biopsy were studied. The following histological parameters were scored semiquantitatively: nodule size, loss of portal tracts and central veins, portal inflammation, periportal inflammation, bile duct proliferation, lobular inflammation, ballooning, fatty change, cholestasis and septal thickness.

Results  On multiple ordinal regression analysis, small nodule size (odds ratio: 21.0; 95% confidence interval: 2.1–208.2, P = 0.009) and thick septa (OR: 42.6; CI: 2.3–783.7, P = 0.011) were significantly associated with the presence of clinically significant portal hypertension. A score was assigned to each of the two parameters (nodule size: large = 1, medium = 2, small = 3 and septal thickness: thin = 1, medium = 2, thick = 3). Two subcategories were devised based on the composite score: category A (n = 12): score 1–3 and category B (n = 35): score 4–6. On ordinal regression, subcategory B (OR: 15.5; CI: 3.3–74.2, P = 0.001) was significantly associated with clinically significant portal hypertension.

Conclusion  Small nodularity and thick septa are independent predictors of the presence of clinically significant portal hypertension.
Dysphagia: epidemiology, risk factors and impact on quality of life – a population‐based study
Authors: ESLICK G. D. , TALLEY N. J.
Published: July 2010

Background  Data on the population epidemiology of dysphagia are scarce. Little is known about the prevalence, risk factors and impact on quality of life of dysphagia in the general community.

Aim  To determine the magnitude and impact of dysphagia in the general community.

Methods  A random sample of 1000 individuals of Sydney, Australia, were mailed a validated self‐report questionnaire to assess dysphagia. Measured were dysphagia symptoms, potential mechanisms, risk factors, psychological disorders, quality of life and demographics.

Results  The response rate of included subjects (n = 926) was 73% (n = 672). Dysphagia ever was reported by 16% (n = 110). Multiple logistic regression analysis found that odynophagia was independently associated with gastro‐oesophageal reflux disease (GERD) (OR = 3.41, 95% CI: 1.16–10.04). Intermittent dysphagia was independently associated with GERD (OR = 2.96, 95% CI: 1.76–4.98) and anxiety (OR = 1.09, 95% CI: 1.01–1.19). The presence of progressive dysphagia was independently associated with depression (OR = 1.34, 95% CI: 1.07–1.67). Progressive dysphagia was independently associated with reduced ‘general health’ (OR = 0.95, 95% CI: 0.90–0.99), while intermittent dysphagia was associated with a reduction in the ‘role physical’ subscale (OR = 0.98, 95% CI: 0.97–0.99).

Conclusions  Dysphagia is remarkably common in the general population. GERD is a risk factor for dysphagia as well as odynophagia. Intermittent dysphagia was associated with anxiety, while progressive dysphagia was associated with depression.
Relationship between symptom load of gastro‐oesophageal reflux disease and health‐related quality of life, work productivity, resource utilization and concomitant diseases: survey of a US cohort
Authors: WAHLQVIST P. , KARLSSON M. , JOHNSON D. , CARLSSON J. , BOLGE S. C. , WALLANDER M.‐A.
Published: July 2010

Background  Analysis of the burden of gastro‐oesophageal reflux disease (GERD) in relation to the severity and frequency of symptoms is essential to identify individuals and groups in whom targeted management is justified.

Aim  To describe the relationship between symptoms of GERD and self‐reported health‐related quality of life (HRQL), work productivity, healthcare utilization and concomitant diseases.

Methods  US respondents to the Internet‐based 2004 National Health and Wellness Survey who had self‐reported GERD (n = 10 028, mean age: 52 years, 58% female) were age‐ and gender‐matched to a control group without GERD (n = 10 028). Respondents with GERD were classified according to symptom severity and frequency. HRQL and productivity were assessed using the Short‐Form 8 survey (SF‐8) and Work Productivity and Activity Impairment questionnaire, respectively.

Results  Symptom frequency increased with increasing symptom severity. Compared with controls, respondents with GERD had more concomitant diseases [mean difference (MD): 1.6], lower SF‐8 physical and mental health scores (MD: 4.1 units and 3.1 units, respectively), increased absenteeism (MD: 0.9 h/week), reduced percent productivity at work (MD: 7.5%) and increased healthcare utilization. All tested variables deteriorated with increasing symptom severity and/or frequency.

Conclusions  Increasing severity and frequency of GERD symptoms is associated with more concomitant diseases, lower HRQL, lower work productivity and increased healthcare utilization, suggesting that patients with moderate or severe GERD should receive targeted management with the most effective treatment strategies.
Proton pump inhibitor therapy in gastro‐oesophageal reflux disease decreases the oesophageal immune response but does not reduce the formation of DNA adducts
Authors: DE JONGE P. J. F. , SIERSEMA P. D. , VAN BREDA S. G. J. , VAN ZOEST K. P. M. , BAC D. J. , LEEUWENBURGH I. , OUWENDIJK R. J. TH. , VAN DEKKEN H. , KUSTERS J. G. , KUIPERS E. J.
Published: July 2010

Background  Chronic oesophageal inflammation and related oxidative stress are important in the pathogenesis of erosive oesophagitis (EO) and its malignant progression.

Aim  To study the effect of proton pump inhibitors (PPIs) on oesophageal cellular immune response and oxidative damage in EO patients.

Methods  Forty gastro‐oesophageal reflux disease (GERD) patients [non‐erosive reflux disease (NERD): 15, EO: 25] were included, after 7 days off antisuppressive drugs. EO patients were randomized to 20‐mg rabeprazole once daily for either 4 or 8 weeks with baseline and follow‐up endoscopy with distal oesophageal biopsies. T lymphocytes, macrophages and mast cells were quantified by immunohistochemistry. DNA adducts were measured by analysis of 8‐oxo‐deoxyguanosine levels.

Results  Erosive oesophagitis patients had more T lymphocytes and CD8+ T lymphocytes in squamous epithelium than NERD patients (P = 0.001, P = 0.002, respectively). Levels of DNA adducts between both groups were, however, not different (P = 0.99). Four‐ and eight‐week rabeprazole treatment in EO patients resulted in a significant decrease in number of T lymphocytes and CD8+ T lymphocytes (all P < 0.05). PPIs did not, however, affect levels of DNA adducts.

Conclusions  Short‐term PPI therapy in EO patients reduces the oesophageal cellular immune response, but does not change oxidative damage. PPI therapy may therefore not be effective in reducing the risk of oesophageal cancer in GERD patients.
National mortality following upper gastrointestinal or cardiovascular events in older veterans with recent nonsteroidal anti‐inflammatory drug use
Authors: ABRAHAM N. S. , CASTILLO D. L. , HARTMAN C.
Published: July 2010

Background  Upper gastrointestinal events (UGIE), myocardial infarction (MI) and cerebrovascular accident (CVA) are known morbities among recent NSAID users.

Aim  To assess all‐cause mortality following UGIE, MI or CVA among recent NSAID users.

Methods  Veterans >65 prescribed an NSAID at any Veterans Affairs (VA) facility were identified using prescription fill data and their records linked to a merged VA‐Medicare database. Each person‐day was assessed for NSAID, coxib or proton pump inhibitor (PPI) exposure. Incidence density ratios and hazard rates of death were calculated following UGIE, MI and CVA adjusting for demographics, co‐morbidity, prescription channeling, geographic location and pharmacological covariates.

Results  Among 474 495 patients [97.8% male; 85.3% white; 73.9 years (s.d. 5.6)], death followed at a rate of 5.5 per 1000 person‐years (95% CI: 5.4–5.6) post‐UGIE, 17.7 per 1000 person‐years (95% CI: 17.5–17.9) post‐MI and 21.8 per 1000 person‐years (95% CI: 21.6–22.0) post‐CVA. CVA was associated with greatest risk of death [hazard ratio (HR) 12.4; 95% CI: 10.9–14.3] followed by MI (HR 10.7; 95% CI: 9.2–11.6) and UGIE (HR 3.3; 95% CI: 2.8–3.9). Predictors of mortality were advancing age and co‐morbidity, increased use of coxibs and failure to ensure adequate gastroprotection.

Conclusion  Among elderly veterans with recent NSAID use, an UGIE, MI or CVA is a clinically relevant premorbid event.
A new co‐axial breathing system
Authors: BURCHETT K. R. , BENNETT J. A.
Published: July 2010

A new, simple, versatile co‐axial breathing system combining the features of Mapleson A, D and E type systems is described. The change from an A system to a D/E system is effected by a single switch and without reversal of the gas flow. Fresh gas flows in the order of 70 ml/kg/min are required for both spontaneous ventilation in the Mapleson A mode and controlled ventilation in the Mapleson D mode. The co‐axial conjiguration offers the advantages of a single, lightweight breathing system with easy scavenging of anaesthetic gases, while the ability to switch between the A and D or E configurations offers the economic advantages of low fresh gas flows and the need for a single anaesthetic breathing system for all situations.
The prolongation of local anaesthetic action with dextran
Authors: NAVARATNARAJAH M. , DAVENPORT H. T.
Published: July 2010

Field blocks of the inguinal region were performed in two groups of patients, in one group using a mixture of 0.5% bupivacaine, 1:200 000 adrenaline and dextran 110 and in the second group using a mixture of 0.5% bupivacaine, 1:200 000 adrenaline and dextran 150; the study being performed in a double‐blind fashion. The dextran 150 mixture produced a highly significant increase (p < 0.01) in the duration of the block when compared with the dextran 110 mixture. The authors conclude that the use of dextran of increasing molecular weight increases the duration of action of local anaesthetics correspondingly.
Tracheal compression caused by aneurysms of the aortic arch
Authors: MacGILLIVRAY R. G.
Published: July 2010

Two cases of severe tracheal compression caused by aortic arch aneurysm are reported. There was a marked similarity in the clinical presentation of these patients but the different outcomes of surgical resection appeared to be related to the content of the aneurysms. The first patient had a fixed obstruction due to solid clot, which proved irreversible; while the second had an aneurysm containing fluid blood. The anaesthetic management of this complication is discussed.
Pulmonary function tests before and after laparoscopic cholecystectomy
Authors: FREEMAN J. A. , ARMSTRONG I. R.
Published: July 2010

Pulmonary function tests were performed in 22 patients undergoing laparoscopic cholecystectomy. Measurements were made before, 24h after, and 6 weeks after operation (12 patients). At 24 h postoperatively there were significant decreases in forced expiratory volume in 1 s, vital capacity, functional residual capacity and total lung capacity to 75% (p < 0.001), 73% (p < 0.001), 92% (p = 0.002) and 83% (p < 0.001) of pre‐operative values respectively. Inspiratory and expiratory mouth pressures decreased to 66% (p < 0.001) of pre‐operative values respectively. Inspiratory and expiratory mouth pressures decreased to 66% (9 < 0.001) adn 63% (p < 0.001) of the pre‐operative pressures respectively. There was a reduction in Pao2 (p < 0.01) and an increase in alveolar‐arterial gradient (p < 0.001) but no change in Paco2 at 24 h. The pulmonary function tests measured in the patients who returned after 6 weeks had returned to pre‐operative values.
Effect of three different surgical prone positions on lung volumes in healthy volunteers
Authors: MAHAJAN R. P. , HENNESSY N. , AITKENHEAD A. R. , JELLINEK D.
Published: July 2010

Ten healthy volunteers were placed in three different surgical prone positions (knee‐chest, Eschmann frame and two supports, one each for the thorax and pelvis); the normal prone position without any supports was used as a control. Lung volumes using helium dilution and spirometery were calculated for each volunteer in each position. Compared with the control position, functional residual capacity, expiratory reserve volume, residual volume and total lung capacity were significantly higher in the knee‐chest position. Functional residual capacity and expiratory reserve volume were significantly higher in the frame position. No advantage was gained with the use of the two supports position. We conclude that, of these three prone positions in awake volunteers, the knee‐chest position causes least respiratory restriction.
A novel approach to insertion of the Montgomery T‐tube
Authors: CHONCHUBHAIR Á. NÍ , O'CONNOR T. , O'HAGAN C.
Published: July 2010

We describe a novel method of inserting a silicome tracheal Montgomery T‐ube using a gum elastic bougie. the advantages of this method over previously described methods ar discussed.
Genetic differentiation among natural European populations of Atlantic salmon, Salmo salar L., from drainages of the Atlantic Ocean
Authors: BLANCO G. , SANCHEZ J. A. , VAZQUEZ E. , RUBIO J. , UTTER F. M.
Published: July 2010

Previously published allelic frequencies at four polymorphic protein coding loci were used as a basis for examining genetic relationships among 19 European populations of Atlantic salmon, Salmo salar L. ‐ exclusive of Baltic drainages ‐ from the Barents Sea to Spain. The data did not support a model of distinct ancestral (e.g. Boreal and Celtic) origins, but were consistent with all populations descending from a single ancestral group within this region with genetically diverged populations drawn together through limited local migrations.
Expression pattern, genomic cloning and RFLP analyses of the swine PIT‐1 gene
Authors: Yu T‐P , Schmitz C B , Rothschild M F , Tuggle C K
Published: July 2010

The swine PIT‐1 POU domain cDNA was used to study PIT‐1 expression and to clone the PIT‐1 genomic region to identify additional PIT‐1 polymorphisms. PIT‐1 was expressed only in the pituitary, confirming the swine cDNA identity. To study the PIT‐1 genomic region, a clone containing 13.7 kb DNA was isolated. EcoRI fragments hybridizing to PIT‐1 were sequenced, and the 3′ portion of PIT‐1 gene identified. Primers for polymerase chain reaction (PCR)‐restriction fragment length polymorphism (RFLP) analysis were then designed. Restriction analysis of PCR products identified a RsaI RFLP. In contrast to other PIT‐1 RFLPs, the RsaI PCR‐RFLP was widely distributed in American breeds. Thus, the RsaI RFLP and the previously reported PIT‐1 RFLPs allow detection of PIT‐1 alleles in most, if not all, breeds currently used in the US and European reference/resource pig mapping families.
Chromosomal assignment of porcine microsatellites by use of a somatic cell hybrid mapping panel
Authors: Rettenberger G. , Fredholm M. , Fries R.
Published: July 2010

A well‐established and characterized somatic cell hybrid panel was used to map three polymorphic microsatellites. Microsatellite S0072, representing the linkage group S0007‐S0072, was assigned to porcine chromosome 14. Micro‐satellite S0009, representing the unassigned linkage group EAM‐S0009‐S0071, was assigned tentatively to porcine chromosome 11. Finally, S0062 was tentatively mapped to chromosome 18. S0062 may represent the first marker for porcine chromosome 18.
Potential role for bone marrow-derived fibrocytes in the orbital fibroblast heterogeneity associated with thyroid-associated ophthalmopathy
Authors: Smith T J
Published: July 2010

Fibroblast heterogeneity has been recognized for decades, but the basis for multiple phenotypes among these cells has been investigated only recently. More than 15 years ago, Bucalla and his colleagues described for the first time a population of fibroblast-like cells among circulating mononuclear blood cells. Subsequently these mesenchymal cells, termed fibrocytes, have been characterized and found to participate in normal and pathological tissue remodelling. In this review, I have attempted to present the evidence generated thus far suggesting that fibrocytes are participants in autoimmune diseases where tissues are injured and undergo remodelling. Aspects of their phenotype suggest that they are well suited to help orchestrate immune responses through mononuclear cell recruitment and their ability to produce inflammatory mediators and extracellular matrix molecules. These attributes also raise the possibility that they might be useful targets against which therapeutic agents might be aimed.
Protein C deficiency
Authors: GOLDENBERG N. A. , MANCO‐JOHNSON M. J.
Published: July 2010

Summary.  Severe protein C deficiency (i.e. protein C activity <1 IU dL−1) is a rare autosomal recessive disorder that usually presents in the neonatal period with purpura fulminans (PF) and severe disseminated intravascular coagulation (DIC), often with concomitant venous thromboembolism (VTE). Recurrent thrombotic episodes (PF, DIC, or VTE) are common. Homozygotes and compound heterozygotes often possess a similar phenotype of severe protein C deficiency. Mild (i.e. simple heterozygous) protein C deficiency, by contrast, is often asymptomatic but may involve recurrent VTE episodes, most often triggered by clinical risk factors. The coagulopathy in protein C deficiency is caused by impaired inactivation of factors Va and VIIIa by activated protein C after the propagation phase of coagulation activation. Mutational analysis of symptomatic patients shows a wide range of genetic mutations. Management of acute thrombotic events in severe protein C deficiency typically requires replacement with protein C concentrate while maintaining therapeutic anticoagulation; protein C replacement is also used for prevention of these complications around surgery. Long‐term management in severe protein C deficiency involves anticoagulation with or without a protein C replacement regimen. Although many patients with severe protein C deficiency are born with evidence of in utero thrombosis and experience multiple further events, intensive treatment and monitoring can enable these individuals to thrive. Further research is needed to better delineate optimal preventive and therapeutic strategies.
Apes in a changing world – the effects of global warming on the behaviour and distribution of African apes
Authors: Lehmann Julia , Korstjens Amanda H. , Dunbar Robin I. M.
Published: July 2010

Aim  In this study we use a modelling approach to identify: (1) the factors responsible for the differences in ape biogeography, (2) the effects that global warming might have on distribution patterns of African apes, (3) the underlying mechanisms for these effects, and (4) the implications that behavioural flexibility might be expected to have for ape survival. All African apes are highly endangered, and the need for efficient conservation methods is a top priority. The expected changes in world climate are likely to further exacerbate the difficulties they face. Our study aims to further understand the mechanisms that link climatic conditions to the behaviour and biogeography of ape species.

Location  Africa.

Method  We use an existing validated time budgets model, derived from data on 20 natural populations of gorillas (Gorilla beringei and Gorilla gorilla) and chimpanzees (Pan troglodytes and Pan paniscus), which specifies the relationship between climate, group size, body weight and time available for various activities, to predict ape distribution across Africa under a uniform worst‐case climate change scenario.

Results  We demonstrate that a worst‐case global warming scenario is likely to alter the delicate balance between different time budget components. Our model points to the importance of annual temperature variation, which was found to have the strongest impact on ape biogeography. Our simulation indicates that rising temperatures and changes in rainfall patterns are likely to have strong effects on ape survival and distribution, particularly for gorillas. Even if they behaved with maximum flexibility, gorillas may not be able to survive in most of their present habitats if the climate was to undergo extreme changes. The survival of chimpanzees was found to be strongly dependent on the minimum viable group size required.

Main conclusions  Our model allows us to explore how climatic conditions, individual behaviour and morphological traits may interact to limit the biogeographical distributions of these species, thereby allowing us to predict the effects of climate change on African ape distributions under different climate change regimes. The model suggests that climate variability (i.e. seasonality) plays a more important role than the absolute magnitude of the change, but these data are not normally provided by climate models.
Surgical management of gastroesophageal reflux in severely mentally retarded children
Authors: CHANG J. H. T. , COLN C. D. , STRICKLAND A. D. , ANDERSEN J. M.
Published: July 2010

ABSTRACT. Thirty‐three severely mentally retarded children with profond malnutrition and aspiration pneumonitis were treated by gastrostomy and Nissen fundoplication. Early and late complications were 27.3% and 16.6% respectively. Mortality was 9.4%. All surviving patients gained weight. Time required for feeding was greatly, reduced. This study supports earlier operative intervention for the mentally retarded child with gastroesophageal reflux, malnutrition and aspiration pneumonitis.