Contribution of coloured duplex ultrasonography to preoperative examination of patients with chronic venous insufficiency

In a prospective study the authors examined by coloured duplex sonography 76 patients (93 extremities) with chronic venous insufficiency (CVI), before a planned operation of the veins of the lower extremities. Attention was focused on the site of the reflux ( superficial, deep venous system, perforators) and the importance of perforators and congenital venous anomalies in CVI. In the investigated group of patients with CVI a combined reflux was present in several venous systems concurrently, confirmed in 69 extremities (74.2%). In 25 extremities the authors found insufficiency of the saphenofemoral junction along with femoropopliteal reflux. This high grade of reflux coincidence in these two neighbouring anatomical areas indicates so-called secondary reflux. Dilated perforators were found in 65 extremities (70%). These insufficient perforators were most frequently on the median side of the leg, regardless whether in the proximal or distal half. Obviously there is direct correlation between the grade of CVI according to the international clinical classification and the number of incompetent perforators. The ratio of inborn venous anomalies in the development of CVI in the authors group of patients was not statistically significant.     

Effect of chronic venous insufficiency on activities of daily living and quality of life: correlation of demographic factors with duplex ultrasonography findings

The study evaluates to what extent symptoms of chronic venous insufficiency (CVI) and functional venous incompetence as investigated using color-coded duplex ultrasonography may interfere with activities of daily living (ADLs). This study comprises a cross-sectional survey conducted in urban areas surrounding 24 Italian cities. A spontaneous sample of 5,187 subjects (4,457 women [mean age, 54 years] and 730 men [mean age, 61 years]), selected by advertising on television and in newspapers, underwent a clinical examination that included duplex ultrasonography in 3 vein segments in both legs to determine the presence and severity of venous reflux. Subjective perception of lower limb symptoms of CVI and the effect of leg problems on the ability to perform normal ADLs are assessed by means of a self-administered questionnaire. Most of the respondents have some CVI symptoms, with women being 1.5 to 3 times as likely as men to report leg symptoms. The risk of developing the most frequent subjective symptoms such as heaviness and tiredness in the legs is not statistically significantly different for younger subjects compared with older subjects. Advanced age is considered to be a relevant risk factor only for heat sensation and swollen legs. Persons living in southern Italy are at higher risk of almost all lower limb symptoms. Results of duplex ultrasonography performed on 3875 subjects show that fewer than 1 in 5 young persons, regardless of sex, manifest some degree of venous reflux (primarily mild symptoms). The risk of developing venous incompetence increases rapidly with age until it triples among subjects 50 years and older. Adjusting for all other factors, men are on average 1.5 times as likely as childless women to have venous reflux, and the risk increases in the case of family history of CVI or (among women) in the case of past pregnancies. More women than men report that their leg problems affect their ADLs. Pregnancy and living in the south contribute to a reduction in the ability to perform most heavy housework. Although milder lower limb symptoms such as evening heaviness and tiredness in the legs may begin early in life, venous reflux and related symptoms of heat sensation and swollen legs become more pronounced with age, and their severity can be disabling for those afflicted.     

Phlebodynamometry studies in patients with chronic venous insufficiency and phlebography verified insufficiency of muscle veins

23 patients with complaints in the sense of a chronic venous insufficiency were examined by means of phlebodynamometry, who phlebographically did not show any postthrombotic changes of the deep conducting veins, but had clear signs of an insufficiency of the muscle veins stage I-III. Cases with isolated insufficiency of the muscle veins (n = 5) and combination forms with additional insufficiency of the conducting veins and/or superficial varicosis (long and short saphenous veins) were found. Measured at the decrease of pressure (delta-p) after exercise in the combined forms the epifascial varicosis has the greatest haemodynamic effects. The isolated findings of an insufficiency of the muscle veins with or without additional insufficiency of the conducting veins has apparently only smaller haemodynamic effects. For the isolated insufficiency of the muscle veins normal limit values for delta-p could still be measured, which also could only insignificantly be bettered by application of a tourniquet. This knowledge is important for therapy planning.     

慢性肾功能不全合并胃食管反流病患者血清尿素氮、血肌酐及食管24hpH值DeMeester评分与胃泌素的相关性

目的探讨慢性肾功能不全合并胃食管反流病患者血清尿素氮、肌酐及食管24 h pH值DeMeester评分与胃泌素的相关性。方法选取南京军区南京总医院门诊慢性肾功能不全合并胃食管反流病的患者42例,测定血清尿素氮、肌酐及胃泌素浓度,并行24 h食管pH监测,结果以DeMeester评分进行统计。观察患者肾功能及DeMeester评分与血清胃泌素的关系。结果血清尿素氮为(31.1±8.5)mg/dl,肌酐为(3.0±1.3)mg/dl,DeMeester评分为65.0±64.1,胃泌素为(63.5±18.7)pg/ml;血清尿素氮、肌酐和DeMeester评分与胃泌素均呈正相关,相关系数R2值分别为0.58、0.49、0.35。结论慢性肾功能不全患者出现胃食管反流症状可能是由于对胃泌素的清除减少和生成增多导致的胃酸分泌增加及反流增多所致。     

Comparison of patients of chronic laryngitis with and without troublesome reflux symptoms

Background and Aim: Little is known about the difference between patients of chronic laryngitis with and without troublesome reflux symptoms. The aim of this study was to compare the clinical characteristics and response to acid suppression between patients of chronic laryngitis with and without troublesome reflux symptoms. Methods: Consecutive patients with chronic laryngitis were enrolled. The frequency and severity of reflux and laryngeal symptoms were scored. All the patients underwent laryngoscopy, esophagogastroduodenoscopy and 24‐h multichannel intraluminal impedance and pH monitoring before receiving rabeprazole 10 mg b.i.d. for 3 months. Mild typical reflux symptoms (heartburn or regurgitation) occurring ≥ 2 days/week or moderate/severe symptoms occurring ≥ 1 day/week were defined as troublesome reflux symptoms. Results: Compared to patients without troublesome reflux symptoms, those with troublesome reflux symptoms were older and had more episodes of acid and liquid gastroesophageal reflux (GER) and acid and weakly acidic laryngopharyngeal reflux (LPR). They also had higher percentages of both bolus exposure time and acid exposure time of GER and LPR. Patients with troublesome reflux symptoms responded to acid suppression more often at 12 weeks (67.3% vs 20.9%, P < 0.001) and more rapidly (40.8% vs 14.0%, 3 weeks after the start of acid suppression; P = 0.004) compared to those without. Conclusion: Difference in reflux profile of GER and LPR between patients with and without troublesome reflux symptoms could partly explain the discrepancy of response to acid suppression among patients with chronic laryngitis. Acid suppression therapy may provide limited therapeutic benefits to patients of chronic laryngitis without troublesome reflux symptoms.     

Expression of MDR proteins in breast cancer and its correlation with some clinical and pathological parameters

The aim of this work was to determine the expression of the multidrug resistance (MDR) proteins, namely MDR1 (P-glycoprotein), MRP1 (multidrug resistance-related protein) and LRP (lung resistance-related protein), in 87 samples of breast carcinoma. Detection of these proteins was provided by using indirect enzymatic immunohistochemistry. Our findings were compared with the other clinical and pathological parameters: expression of Her2/neu, estrogen receptor status (ER), progesteron receptor status (PR), histological grade and regional lymph node status. For statistical analysis, non-parametric two sided Mann-Whitney-U test was used. Majority of breast carcinoma specimens show positivity for these proteins. The MDR1 and MRP1 signal was found in the cytoplasm of cancer cells. The expression of LRP was detected in the cytoplasm close to the nuclear membrane. The samples were positive for MDR1 protein in 57%, for MRP1 in 84% and for LRP in 79%. Comparing our results with other clinical and pathological parameters, negative correlation between ER, PR and MDR1 expressions and histological grading status was found. No associations were observed between the MRP1 and LRP proteins and histological grading, as well as between the expression of three MDR proteins and the other clinically relevant parameters. In conclusion, high frequency of expression of MDR proteins in breast carcinoma cells suggests, that these proteins might be an important factor of drug resistance in breast carcinoma. Nevertheless, the negative correlation between the histological grade of malignancy of tumor and the expression of ER, PR and MDR1 indicates possible influence of progressive tumor cell de-differentiation. However, this finding has to be confirmed in additional evaluations.     

Therapeutic approach to chronic venous insufficiency and its complications: place of Daflon 500 mg

Early manifestations of chronic venous insufficiency (CVI) are edema, hyperpigmentation, and lipodermatosclerosis. Late complications are cutaneous ulceration and delayed healing. The specific hallmarks of this inflammation include CD68-positive infiltration into the dermal tissue, monocytes, and lymphocytes and enhanced endothelial permeability. This may lead to "fibrin cuff" formation. In addition, membrane adhesion molecules are present and cytokine expression is seen. In one experimental model of mesenteric venous hypertension, the inflammatory process was detected in its earliest stages. This was evident in the form of neutrophilic leukocyte adhesion to venular endothelium as well as migration of cells across the endothelium and basement membrane into the interstitial space. Simultaneously, parenchymal cell death was detected. This suggests that the mechanism that triggers the inflammatory reaction is venous hypertension. This may cause venous distension and a shift in fluid shear stress. Our observations suggest that patients with venous insufficiency demonstrate circulatory humoral stimulators for leukocyte activation. Otherwise, there is evidence that the inflammatory reaction is limited to the region of the venous ulceration or at least to the skin areas with severe microangiopathy. It may be that activated leukocytes traverse perivascular cuffs and release active transforming growth factor-beta1 (TGF-beta1) which has been found to be elevated exclusively in areas of clinically active CVI. Surgical intervention markedly decreases the number of dysfunctional vein segments and allows pharmacologic agents to protect normal structures from continuing damage. Daflon 500 mg, the purified micronized flavonoid fraction containing 90% diosmin and 10% hesperidin, acts favorably in venous ulcer treatment by inhibiting the synthesis of prostaglandins and free radicals. It decreases bradykinin-induced microvascular leakage and may act favorably to inhibit leukocyte activation, trapping, and migration. Clinically, edema is reduced, ulcer healing is accelerated, and leukocyte trapping diminished. The action of micronized purified flavonoid fraction is beginning to be better understood, and as further knowledge is gained, better pharmacologic control of CVI is a tantalizing promise.     

Esophageal capsule endoscopy for evaluation of patients with chronic gastroesophageal reflux symptoms: findings and its image quality

Esophageal capsule endoscopy (ECE) may offer an alternative approach to visualize esophageal lesions associated with gastroesophageal reflux (GER) disease. The objective of this study was to report the ECE findings in patients with GER symptoms and validate a new scoring system to assess ECE video quality. Five hundred two ECE were performed in patients with GER symptoms. We devised a new grading scale called ECE Utility score to assess the quality of images using five different parameters: anatomic landmarks visualized, esophageal transit time, image quality, illumination, and artifacts. The ECE cases were independently scored by two interpreters in a randomized, blinded fashion. Reflux esophagitis was diagnosed via ECE in 254 patients (50.5%). We identified 12 cases (2.4%) with suspected Barrett's esophagus and all of them had endoscopic evidence of Barrett's esophagus on esophagogastroduodenoscopy. Histologic confirmation Barrett's esophagus was found in six patients and dysplasia was found in one patient. From the 502 cases, mean ± standard deviation total ECE Utility score was 8.89 ± 0.96 for interpreter 1 and 8.96 ± 0.93 for interpreter 2. The concordance rate between the two interpreters for the ECE Utility score ranged from 75.9–96.8% across the parameters and the Pearson correlation rate of the total score was 0.81. ECE is shown to be a simple noninvasive valuable technique for evaluating esophageal mucosa and producing high quality images in patients with GER symptoms. ECE can help as an alternative screening tool for diagnosing Barrett's esophagus.     

Intestinal metaplasia in the distal esophagus and correlation with symptoms of gastroesophageal reflux disease

Barrett's esophagus is a metaplastic condition that occurs in patients with gastroesophageal reflux disease (GERD) and its importance lies in its potential to develop adenocarcinoma of the esophagus. The diagnosis of Barrett's esophagus is based on finding of intestinal metaplasia of at least 3 cm of the distal esophagus. The diagnosis of intestinal metaplasia of less than 3 cm of the distal esophagus is controversial, regarding implications with GERD, adenocarcinoma, and Helicobacter pylori. The aims of the study were to determine the prevalence of intestinal metaplasia in the distal esophagus in patients with short segments of esophageal columnar-appearing mucosa (less than 3 cm), diagnosed endoscopically, in two groups of patients, with and without symptoms of GERD. In total, 97 patients were examined, with endoscopic finding of esophageal columnar-appearing mucosa less than 3 cm. From the total, 52 patients had symptoms of GERD and 45 patients were without these symptoms. These patients were subjected to distal esophageal biopsies obtained immediately below the epithelial transition. The biopsies were stained with hematoxylin-eosin and alcian blue at pH 2.5. Urease test for H. pylori detection in two fragments of gastric antrum was carried out. The presence of intestinal metaplasia in the distal esophagus was diagnosed in 16 (30.8%) patients in the GERD group and 12 (26.7%) patients without GERD symptoms. No statistical differences were observed (P = 0.82; 95% CI: 0.61-2.17). The variables sex, mean age and positivity for H. pylori did not show statistical differences. This study diagnosed high prevalence of intestinal metaplasia in the distal esophagus with columnar-appearing mucosa, less than 3 cm, with no statistical differences in the two groups studied with and without GERD symptoms.     

胃食管反流病中非酸反流的比例及其与烧心的关系

目的 应用食管联合阻抗-pH监测技术探讨胃食管反流病中非酸反流的比例及其与烧心的相关程度.方法 选取消化专科门诊以烧心为主诉的连续病例,通过上消化道内镜将上述患者分为糜烂性食管炎(EE)组和非糜烂性反流病(NERD)组,并进一步通过24 h食管多通道腔内阻抗-pH监测及雷贝拉唑试验性治疗予以确诊.比较两组的联合阻抗-pH监测指标.结果 EE组36例,NERD组62例.两组患者酸反流次数、酸反流时间百分比差异有统计学意义(P值分别=0.001和0.002).EE组和NERD组中非酸反流次数的百分比分别为37.3%(663/1777)和44.3%(1220/2754),差异有统计学意义(x=21.723,P=0.000).EE组酸反流烧心症状指数阳性、非酸反流烧心症状指数阳性及总反流烧心症状指数阳性的百分比分别为36.1%(13/36)、19.4%(7/36)和55.6%(20/36),NERD组则为27.4%(17/62)、6.4%(4/62)和33.8%(21/62).结论 EE组和NERD组患者中非酸反流次数的比例分别为37.3%及44.3%,非酸反流与烧心关系密切.     

Gastroesophageal reflux symptoms and nasal symptoms affect the severity of bronchitis symptoms in patients with chronic obstructive pulmonary disease

Background

Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). Extrapulmonary comorbidities, such as gastroesophageal reflux disease (GERD) and post-nasal drip, also cause bronchitis symptoms. The impact of extrapulmonary comorbidities on the severity of bronchitis symptoms in COPD is unknown. The aim of this study was to quantify bronchitis symptoms and assess the impact of GERD and nasal symptoms on the severity of bronchitis symptoms in COPD.

慢性心力衰竭患者心肌HSP47表达及其与某些因素的相关性

目的 探讨慢性心力衰竭患者心肌热休克蛋白47（HSP47）的表达及其与某些因素的相关性。方法 60例手术患者,采用实时荧光定量（RT-PCR）方法 检测心肌HSP47的mRNA表达量。结果HSP47mRNA在慢性心力衰竭患者中均有表达,且随心功能的下降HSP47表达升高。①慢性心力衰竭患者心肌HSP47与左室舒张末期内径呈独立、显著的正相关（r=0.785,P<0.05）,与左室射血分数呈负相关（r=-0.804,P<0.05）;②HSP47与年龄、血脂等无相关关系。结论 慢性心力衰竭患者心肌HSP47表达随心功能下降而升高,与左室舒张末期内径呈正相关,而与左室射血分数呈负相关。