Changes in gastrointestinal permeability in celiac disease

Increased gastrointestinal permeability was found in celiac disease already 20 years ago. Originally a genetical defect was supposed leading to elevated permeability and later to celiac disease. However, patients under long-term gluten-free diet normalized their permeability tests. On the other side, unaffected relatives of patients with celiac disease showed high permeability but not different from patients with irritable bowel syndrome and with a tendency for normalization during follow-up. In active symptomatic celiac disease, permeability is elevated in the gastroduodenum - measured by sucrose test - as well as in the small intestine - measured by lactulose/mannitol ratio. The sensitivity in active celiac disease is high (near 100%), the specificity is low due to high permeability in many intestinal diseases as in acute infectious gastroenteritis, Crohn's disease, nonsteroidal anti-inflammatory drug treatment, etc. In contrast, lactulose/mannitol test permeability is much less sensitive in silent celiac disease without diarrhea (74%). The real importance of permeability disease is established by its use for follow-up of celiac patients under gluten-free diet whereas it is correlated to the degree of mucosal atrophy. In vitro tests also show increased lactulose mucosal to serosal flux in celiac disease, but not correlated to oral permeability test. In conclusion, lactulose/mannitol test is the only noninvasive functional test in celiac disease which has essential importance in active celiac disease and in follow-up under diet.     

莱姆病治疗进展

莱姆病是一种由伯氏疏螺旋体所引起的,以硬蜱为主要传播媒介的自然疫源性疾病。对莱姆病的治疗主要是早期使用抗生素。莱姆病是一种全身性慢性传染病,临床表现复杂多样,侵犯多系统多器官引起损伤,根据其病程发展可分为早中晚三期,而针对不同分期、不同表现及不同发病人群的莱姆病其治疗方法又各不相同,本文将对此进行详细综述。     

Declining prevalence of rheumatic heart disease in rural schoolchildren in India: 2001-2002

BACKGROUND: Rheumatic heart disease is still a major health problem in developing countries such as India and, for the health planners to allocate funds, the actual prevalence of the disease should be known. This study aimed to assess the prevalence of rheumatic heart disease in rural school children in India. METHODS AND RESULTS: A total of 229,829 children between 6 and 18 years of age were screened as part of a school health program. All children with a valvar heart disease detected by the screening doctor were referred to a tertiary care center for evaluation by a cardiologist. The presence of cardiac lesions was confirmed by color Doppler examination. All children with known congenital heart disease were excluded from this study. A total of 374 children were found to have heart disease. Of these, 157 children were found to have rheumatic heart disease, confirmed by echocardiogram. Thus, the current prevalence of rheumatic heart disease is 0.68 per 1000 children. CONCLUSIONS: In the largest school survey conducted to date in India, we report the prevalence of rheumatic heart disease to be 0.68 per 1000 children. Our study suggests that there may have been a dramatic decline in the prevalence of rheumatic heart disease in India.     

Celiac disease in adult patients with type 1 diabetes mellitus in Tunisia

OBJECTIVE: Type1 diabetes mellitus may be associated with celiac disease. The prevalence of celiac disease as determined by screening among adult patients with type 1 diabetes is high with rates of 1.07.8% in Europe and U.S.A. The aims of the study are to determine the prevalence of celiac disease in adults with type 1 diabetes in Tunisia. METHODS: 348 consecutive adult patients with type1 diabetes were investigated prospectively and screened for celiac disease. The mean age was 28.45+/-10.74 years old. There were 176 females and 172 males. For the screening of celiac disease, we used immunoglobulin A (IgA) anti-endomysium (EMA) antibodies determined by an indirect immunofluorescence method. Anti-transglutaminase (tTG) antibodies were determined by an ELISA method. Those patients with positive results for anti EMA and or tTG were proposed for duodenal biopsy. RESULTS: 14 patients were positive for anti EMA and had high or a weak positive level of tTG antibodies. One patient from this group was already known to have celiac disease. Only 8 patients consented to biopsy and morphological changes were consistent with celiac disease in all cases. Prevalence of biopsy-proven celiac disease was 2.3% (95% CI=1.0-4.5%). CONCLUSION: The present study confirms that celiac disease of adults is prevalent in type 1 diabetic patients in Tunisia. Serological screening for celiac disease in type 1 diabetes is important because many patients are asymptomatic and most are detected by the screening.     

Electrocardiographic findings in myotonic dystrophy.

Sixty five patients with myotonic dystrophy, from a defined population in northern Sweden with an extremely high prevalence of this disease, were examined by electrocardiography. The patients were subdivided into three groups according to the severity of the disease. Abnormal electrocardiograms were found in 6 (35%) patients with mild disease, 12 (50%) patients with moderate disease, and 23 (96%) patients with severe disease. First degree atrioventricular block and left anterior hemiblock were the most commonly encountered abnormalities in patients with mild and moderate disease, whereas atrial fibrillation and flutter, abnormal Q waves, and repolarisation abnormalities were more common in patients with severe disease. This study shows that the heart is often affected by myotonic dystrophy. These effects can be detected by electrocardiography in early and mild forms of the disease. The effect on the heart is progressive and clinically important atrial arrhythmias and electrocardiographic abnormalities which are useful in differential diagnosis are common in severe forms of the disease.     

Sucralphate-technetium scintigraphy in inflammatory bowel disease: experience in 23 patients

Serial abdominal scanning after the oral administration of sucralphate-99mTc was performed in order to determine the extent of active inflammatory bowel disease in 15 patients with Crohn's disease and in 8 patients with ulcerative colitis. Scintigraphic data were compared with those obtained by endoscopy and radiology in all patients. True positive scans were obtained in 6 (40%) patients with Crohn's disease and in 3 (38%) patients with ulcerative colitis. Overall, sensitivity was higher in colonic disease than that in ileal disease. In 4 (17%) patients, false negative scans were obtained and in the remaining 10 (44%) patients, localisation of the inflammatory bowel disease by the isotope was completely inaccurate. Since sensitivity of the sucralphate-99mTc scintigraphy appears to be low, its widespread use in the screening for inflammatory bowel disease or in assessing the extent of disease involvement cannot be advocated at this moment.     

Change in serum G-CSF levels in patients with Graves' disease by treatment with methimazole]

We evaluated the determination of serum G-CSF in the diagnosis of granulocytopenia due to methimazole (MMI) in 54 patients with Graves' disease, while they were being treated with MMI, by way of measuring WBC counts and serum levels of G-CSF, thyroid hormones, IgE, and interleukin-2. Serum TSH was measured by immunoradiometric assay, serum G-CSF was done by enzyme immunoassay, thyroid hormones and IgE were done by radioimmunoassay, and serum Interleukin-2 was done by enzyme-linked immunosorbent assay. The population whose G-CSF levels were higher than the minimum detectable level (30pg/ml) was 6 (30%) in normal subjects, 4 (22%) in patients with untreated Graves' disease, 2 (12%) in patients with treated euthyroid Graves' disease, 3 (23%) in patients with Graves' disease who had gone through agranulocytosis, and 2 (33%) in patients with Graves' disease complicated with granulocytopenia. There was no significant change in WBC counts for 4 weeks, but there was a significant difference between WBC counts before treatment and those at 8 weeks after treatment. We observed no significant change of serum G-CSF levels in patients with Graves' disease under treatment. However, there were significantly high levels of serum G-CSF and significantly low counts of WBC in patients with Graves' disease complicated with granulocytopenia induced by MMI, compared with those in normal subjects, patients with untreated Graves' disease, patients with treated euthyroid Graves' disease, and patients with euthyroid Graves' disease who had gone through agranulocytosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cardiac Imaging in Carcinoid Heart Disease

Carcinoid disease is caused by neuroendocrine tumors, most often located in the gut, and leads in approximately 20% of cases to specific, severe heart disease, most prominently affecting right-sided valves. If cardiac disease occurs, it determines the patient’s prognosis more than local growth of the tumor. Surgical treatment of carcinoid-induced valve disease has been found to improve survival in observational studies. Cardiac imaging is crucial for both diagnosis and management of carcinoid heart disease; in the past, imaging was accomplished largely by echocardiography, but more recently, imaging for carcinoid heart disease has increasingly become multimodal and warrants awareness of the particular diagnostic challenges of this disease. This paper reviews the pathophysiology and manifestations of carcinoid heart disease in light of the different imaging modalities.     

Angiotensin-converting-enzyme (ACE) in Crohn's disease]

Serum concentration of angiotensin-converting enzyme (ACE) were measured in 34 patients with Crohn's disease. ACE was decreased in Crohn's disease compared with healthy controls. Significant negative regression between ACE and CDAI was observed. It suggested intestinal ACE may play a regulatory role in intestinal inflammation of Crohn's disease. Among the patients, ACE did not show the significant change by use of prednisolone nor by location of disease. The mechanism of ACE decrease in Crohn's disease was not known, but this phenomena may be one of the reason of persistent inflammation of Crohn's disease.     

Myocardiocyte apoptosis in heart failure in chronic Chagas' disease

Chagas' disease is caused by the parasite Trypanosoma cruzi. The disease affects 16-18 million patients in South America and heart involvement is the major cause of morbidity and mortality of the disease. The myocarditis observed during the chronic phase affects patients independently of the clinical manifestation, although patients with heart failure present an intense degree of myocarditis and fibrosis. To address the pathogenesis of heart failure in Chagas' disease, we investigated the role of myocardial cell loss by apoptosis in patients in the chronic phase of Chagas' disease. Apoptosis was also evaluated in inflammatory cells. Twenty-two specimens of the left ventricle were obtained during autopsies. Eleven samples from patients with heart failure and equal number from patients without heart failure. The material was analyzed by TUNEL methods to identify early apoptotic events and fibrosis was evaluated on HE-stained slides. In patients with heart failure, the extent of fibrosis and the number of apoptotic myocardial and inflammatory cells were significantly higher than in specimens obtained from patients without heart failure. These results suggest that myocardial cell loss by apoptosis and fibrosis contribute to heart failure in the chronic phase of Chagas' disease.     

64－MSCT联合DCG对冠心病的诊断价值

目的分析64排螺旋CT(64－MSCT)联合动态心电图(DCG)对冠心病的诊断价值。 方法选取2016年5月至2017年10月胶州市人民医院收治的83例疑似冠心病患者,均行冠状动脉造影(CAG)、64－MSCT、DCG检查,统计各方法检出冠心病情况,并以CAG检查结果为准,对比64－MSCT检查、DCG检查、联合检查诊断冠心病的灵敏度、准确度、特异度、阳性预测值、阴性预测值。 结果83例疑似冠心病患者：CAG检出44例冠心病,39例无冠心病;64－MSCT检出42例冠心病,41例无冠心病;DCG检出39例冠心病,44例无冠心病;联合检查检出43例冠心病,40例无冠心病。联合检查的灵敏度、准确度、特异度、阳性预测值、阴性预测值高于单一64－MSCT检查、DCG检查(P<0.05)。 结论采用64－MSCT联合DCG诊断冠心病价值较高,值得推广。     

乳糜泻诊断的研究进展

乳糜泻(CD)是具有遗传易感性的个体因摄入麸质而触发的一种免疫介导的全身性疾病。其特点为小肠(尤其是空肠)黏膜绒毛的萎缩以及营养物质吸收不良,禁食含麸质的食物(小麦、黑麦、大麦)能使症状缓解,再进食可迅速复发。以往认为本病少见,目前世界范围的流行病学资料证实其发病率并不低且逐渐增加。本文就CD诊断的研究进展作一综述。     

Regional variation in self-reported heart disease prevalence in Canada

BACKGROUND: Cardiovascular disease is the leading cause of death in Canada. OBJECTIVE: To provide an analysis of the self-reported prevalence of heart disease and three specific cardiac conditions--myocardial infarction (MI), angina and congestive heart failure (CHF)--in subgroups of the Canadian population. METHODS: Data from the Public Use Microdata File from Statistics Canada's 2000/2001 Canadian Community Health Survey (CCHS) were used to estimate the crude self-reported prevalence of heart disease, MI, angina and CHF in Canada. The data are reported by age and sex groups, as well as by province or territory and health region. RESULTS: Based on the 2000/2001 CCHS data, it was estimated that among Canadians 12 years of age and older, 5.0% (n=1,286,000) have heart disease, 2.1% (n=537,000) have had a heart attack, 1.9% (n=483,000) have angina and 1.0% (n=264,000) have CHF. Marked variation in the prevalence of heart disease and the other specific cardiac conditions exists across age and sex groups, and across geographical regions. The prevalence of heart disease is low among those younger than 50 years; thereafter, the prevalence of heart disease increases and is more common among men than among women. By 70 years of age, at least one in four men and one in five women report having heart disease. Large differences in the burden of heart disease were observed across provinces, territories and health regions. Comparison of the highest and lowest prevalence rates among provinces and territories revealed a 1.9-fold difference for heart disease, a 2.8-fold difference for MI, a 2.3-fold difference for angina and a 3.3-fold difference for CHF. CONCLUSIONS: Large regional differences in the prevalence of heart disease and other specific cardiac conditions were observed across Canada. These data may assist health system planners to identify those regions and population subgroups most affected by heart disease, and to support the development of heart disease prevention and treatment programs.     

Danon病临床研究进展

Danon病是一种X连锁显性遗传性溶酶体病,以肥厚型心肌病、骨骼肌病和智力障碍三联征为主要临床表现,其引起的心肌病变与典型的肥厚型心肌病相似.Ⅱ型溶酶体相关膜蛋白是一种高度糖基化的蛋白质,是溶酶体膜的重要组成成份,编码Ⅱ型溶酶体相关膜蛋白的基因突变是导致Danon病的重要病因.现对Danon病的发病机制及其临床特点作一综述.     

Racial differences in disease phenotypes in patients with Crohn's disease

BACKGROUND: Our objectives were to assess the differences in perforating disease behavior, disease severity, and extraintestinal manifestations (EIM) in patients with Crohn's disease (CD) by race. MATERIALS AND METHODS: We identified outpatients with CD evaluated at the University of Maryland Gastroenterology Faculty Practice office or the Baltimore Veterans Affairs Maryland Health Care System, from 1997 to 2005. We assessed age at diagnosis, disease behavior, disease location, need for surgery and EIM. RESULTS: Race was not associated with perforating disease behavior (relative risk [RR] 0.79, 95% confidence interval [CI] 0.46-1.35), need for surgery (RR 0.89, 95% CI 0.56-1.12), and EIM of CD (RR 0.77, 95% CI 0.46-1.27). White patients were significantly more likely to have ileal disease, whereas African American patients were significantly more likely to have ileocolonic and colonic disease. Age at diagnosis younger than 40 years (odds ratio [OR] 4.41, 95% CI 1.84-10.56) and ileocolonic disease (OR 2.39, 95% CI 1.24-4.63) were independent risk factors for perforating disease behavior. Similarly, age at diagnosis younger than 40 (OR 2.79, 95% CI 1.45-5.33), ileal disease (OR 3.76, 95% CI 1.66-8.48), and ileocolonic disease (OR 2.57, 95% CI1.21-5.46) were associated with the need for surgery. Female gender (OR 4.23, 95% CI 1.87-9.58) and a positive family history of CD (OR 3.45, 95% CI 1.49-8.0) were associated with joint manifestations of CD. DISCUSSION: We did not detect differences in disease behavior, severity, or joint EIM by race. Although African American patients were more likely to have ileocolonic or colonic disease, these factors did not affect disease behavior or severity.     

Seasonality in live births with congenital heart disease in Malta.

This study was carried out to analyse seasonal variations in live births with congenital heart disease in the overall population of Malta. Included were all patients diagnosed as having congenital heart disease by echocardiography, cardiac catheterization, surgery or post mortem, by 1 year of age, and who were born between in Malta between 1990 and 1994. Results were analysed by X2 and by Edwards' cyclic method. There were 231 cases of live born congenital heart disease, which were divided into 114 cases not requiring intervention and 117 cases requiring intervention. Although the overall prevalence of congenital heart disease did not demonstrate any seasonal variation, the lesions requiring intervention showed a significant peak in September by Edwards' method (p = 0.03), which was enhanced by seasonal analysis (p = 0.003). These results were confirmed by conventional X2 and X2 for trend. The lesions not requiring intervention, which were comprised almost entirely (96%) of mild pulmonary stenosis and small ventricular septal defects, failed to show any seasonal trend. The literature regarding such seasonal trends in these malformations and statistical analysis of seasonality of congenital heart disease are reviewed. An environmental factor such as a maternal viral infection or treatment of such infections during the first trimester of pregnancy from November to January may precipitate congenital heart disease in predisposed Maltese foetuses.     

Clinical genetics and genetic counseling in Alzheimer disease

Because of growing evidence for genetic causes of Alzheimer disease, clinicians are often asked about risks for this disorder among relatives of patients. This paper briefly reviews the evidence for genetic and other causes of Alzheimer disease, including specifically its typical late-onset variant. Several recent developments in the molecular genetics of early-onset Alzheimer disease are described briefly. These findings, however, may not apply to more typical, late-onset Alzheimer disease. Genetic studies of the latter disorder are complicated by the censorship of any inherited predisposition to disease by death from other causes. Hence, heritable disease may be apparent only in families with large numbers of elderly relatives at risk. Relying on empiric observations of risk among relatives from several recent studies of pooled Alzheimer families, curves are presented describing theoretic age-specific risks in relatives of patients and unaffected controls. Real (current) lifetime risks of Alzheimer disease are then estimated by modification of the theoretic figures with corresponding current age-specific mortality characteristics of the U.S. population. The lifetime incidence among relatives of patients with Alzheimer disease is estimated to be 19%, or three to four times the risk among control relatives. Because both mortality of and risk for Alzheimer disease change rapidly with advancing age, it may be possible to reduce the current morbidity from Alzheimer disease by 50% if onset can be postponed by only 5 years.     

Multimorbidity in the community-dwelling elderly in urban China

ObjectivesThe primary objective of the study was to investigate the prevalence and patterns of multimorbidity in the community-dwelling elderly in urban China.MethodsBy a cluster random sampling method, 2452 persons aged 60 years and older were enrolled as the subjects in an urban community in Nanjing, China. Data on 13 chronic diseases were collected by interviews, physical check-ups and support by physicians. Factor analyses and the logistic regression models were performed to analyze the patterns of multimorbidity.ResultsThe prevalence of multimorbidity was 49.4% in the community-dwelling elderly in urban China. The observed prevalence of 6 chronic disease pairs was higher than their expected prevalence, including hypertension and diabetes, hypertension and coronary heart disease, hypertension and dyslipidaemia, diabetes and cataract, diabetes and hearing disorder, hypertension and stroke. Three patterns were detected as follows: the first pattern with a prevalence of 9.5% covered degenerative diseases (hearing disorder, cataract, joint disease) and cancer; The second pattern with a prevalence of 1.7% was characterized by liver disease, lung disease, gastrointestinal disease; And the third pattern with a prevalence of 22.4% was characterized by cardiovascular diseases (dyslipidaemia, hypertension, coronary heart disease), metabolic diseases (diabetes) and kidney disease. Compared with <70 years, ≥80 years were found as the risk factor of the prevalence of three patterns.ConclusionA significant proportion of elderly populations was affected by multimorbidity in urban China. Specific patterns of multimorbidity were found at group level and the prevalence was associated with age.     

Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders

The prevalence of scleroderma-type capillary abnormalities, as observed by in vivo microscopy, was determined in 173 patients from three rheumatic disease centers. The patients had a variety of connective tissue diseases: scleroderma (systemic sclerosis) 50; systemic lupus erythematosus 60; mixed connective tissue disease 26; Raynaud's disease 11; other rheumatic disorders 26. Enlarged and deformed capillary loops surrounded by relatively avascular areas, most prominently in the nailfolds, were found in 82% of patients with scleroderma and in 54% with mixed connective tissue disease. The rarity of these abnormalities in systemic lupus erythematosus (2%) despite the presence of Raynaud's phenomenon suggests that they are not an expression of the Raynaud's phenomenon frequently associated with scleroderma and mixed connective tissue disease. The single patient with Raynaud's disease and sclerodermatype capillary changes subsequently developed scleroderma.     

Importance of serum albumin values in nutritional assessment and inflammatory activity in patients with Crohn's disease]

BACKGROUND: The serum albumin concentration has frequently been regarded as an indicator of nutritional status, although the hypoalbuminemia may reflect an acute phase protein response during inflammation mediated by cytokines. Both hypoalbuminemia and malnutrition are observed in Crohn's disease. OBJECTIVES: To correlate the serum albumin values to disease activity and also to nutritional status in patients with Crohn's disease. PATIENTS/METHODS: Thirty six patients were studied. Nutritional status was assessed by anthropometry measures and inflammatory activity determined by Harvey's simple clinical index and erythrocyte sedimentation rate. RESULTS: No correlation was found between malnutrition and hypoalbuminemia. The serum albumin levels correlated inversely with the disease activity. Hypoalbuminemia was 100% sensitive for detection of disease activity. CONCLUSION: This study suggests that serum albumin concentration is a very sensitive marker of inflammatory activity and not good indicator of the nutritional status in Crohn's disease. It is necessary a suitable laboratorial parameter for routine nutrition assessment in patients with this inflammatory bowel disease.