Comparison of transarterial chemoembolization and percutaneous acetic acid injection as the primary loco-regional therapy for unresectable hepatocellular carcinoma: a prospective survey

BACKGROUND: Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective loco-regional therapies for hepatocellular carcinoma (HCC). AIM: To compare the therapeutic efficacy of TACE vs. PAI for unresectable HCC. METHODS: A total of 310 patients with unresectable HCCs (size 相似文献   

肝细胞癌化疗栓塞后经皮瘤内注射无水乙醇的疗效

目的比较肝动脉化疗栓塞术(THAE)后经皮瘤内注射无水乙醇(PEI)与单纯THAE治疗单个肝细胞癌的疗效。方法53例肝细胞癌随机分成A(26例)、B(27例)两组。A组单纯THAE治疗;B组THAE治疗后,在CT引导下行PEI治疗。结果THAE组肿瘤治疗的部分缓解率为26.7%,1、2、3年生存率分别为56.0%、30.0%、0.0%。THAE+PEI组肿瘤治疗的部分缓解率为55.5%(P<0.05),1、2、3年生存率分别为91.0%、57.0%、22.0%(P<0.05)。结论THAE+PEI较单纯THAE对单个肝细胞癌的治疗更安全有效。     

Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis

Background  Transcatheter arterial chemoembolization (TACE) has been limited in palliative treatment of unresectable hepatocellular carcinoma (HCC) with major portal vein (PV) invasion due to the possibility of liver failure following embolization. Transcatheter arterial chemoinfusion (TACI) has been an option in such cases.
Aim  To compare clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion.
Methods  We compared clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion. From 2005 to 2007, 110 HCC patients with major PV thrombosis were treated with TACE ( n  = 49) or TACI ( n  = 61).
Results  The morbidity rate was similar for both TACE (6.1%) and TACI (6.5%) patients, and complications were adequately managed using medical treatment. The Kaplan–Meier survival analysis showed that the survival period was significantly longer for the TACE group (median: 14.9 months) than for the TACI (median: 4.4 months) group ( P  < 0.001). There was a higher probability of death in the TACI group than in the TACE group in both our multivariate Cox-proportional hazards (OR 3.09, P  < 0.001) and the propensity score-matched (27 pairs) cohort analyses (OR 2.27, P  = 0.024).
Conclusions  Transcatheter arterial chemoembolization can be safely performed in HCC patients with main PV occlusion. Compared with TACI, TACE may result in longer survival of HCC patients with major PV occlusion.     

Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis

BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.     

Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case-control study

Background  Patients with peptic ulcer bleeding and uraemia are prone to re-bleeding.
Aim  To compare the efficacy of an intravenous proton pump inhibitor in treating peptic ulcer bleeding in patients with uraemia and those without uraemia.
Methods  High-risk peptic ulcer bleeding patients received endoscopic therapy with epinephrine (adrenaline) injection plus intravenous omeprazole (40 mg bolus followed by 40 mg infusion every 12 h) for 3 days. Re-bleeding, volume of blood transfusion, hospital stay, need for surgery, and mortality were analysed.
Results  The uraemic group had similar 7-day re-bleeding rate (6/42, 14.29% vs. 6/46, 13.04%, P  =   0.865) to that of non-uraemic patients, but more re-bleeding episodes beyond 7 days (4/42, 9.52% vs. 0/46, 0%, P  =   0.032, OR [95% CI] = 1.105 [1.002–1.219]) and all-cause mortality (4/42 vs. 0/46 P  =   0.032, OR [95% CI] = 1.105 [1.002–1.219]). The uraemic group also had more units of blood transfusion after endoscopic therapy (mean ± s.d. 4.33 ± 3.35 units vs. 2.15 ± 1.65 units, P  <   0.001), longer hospital stay (mean ± s.d. 8.55 ± 8.12 days vs. 4.11 ± 1.60 days, P  <   0.001) and complications during hospitalization (9/42 vs. 0/46, P  =   0.001, OR [95% CI] = 1.273 [1.087–1.490]).
Conclusion  Endoscopic therapy with epinephrine injection plus an intravenous proton pump inhibitor can offer protection against early re-bleeding in uraemic patients with peptic ulcer bleeding, but has a limited role beyond 7 days.     

Incidence of benign upper respiratory tract infections, HSV and HPV cutaneous infections in inflammatory bowel disease patients treated with azathioprine

Background  There are few data on the incidence of benign infections (upper respiratory tract infections, herpes lesions and viral warts) during exposure to azathioprine.
Aims  To determine the incidence of benign infections in IBD out-patients receiving azathioprine (AZA+) and to look at the influence of leucocyte counts in the onset of these events.
Methods  A total of 230 patients were included in a prospective cohort and observed during 207 patient-years. Episodes of benign infections were collected and incidences of benign infections were compared between the AZA+ group and patients without AZA (AZA−).
Results  The incidence of upper respiratory tract infections in the cohort was 2.1 ± 2.2 per observation-year. There was no difference between the AZA+ ( n  = 169) and AZA− ( n  = 61) groups (2.2 ± 2.3 vs. 2.1 ± 2.1, P  = 0.77). The incidence of herpes flares was significantly increased in the AZA+ group compared to the AZA− group (1.0 ± 2.6 vs. 0.2 ± 0.8 per year, P  = 0.04). Similarly, there were significantly more patients with appearance or worsening viral warts in the AZA+ group (17.2% (AZA+) vs. 3.3% (AZA−), P  = 0.004).
Conclusion  This study suggests that the incidence of herpes flares and the appearance or worsening of viral warts are increased in IBD patients receiving AZA.     

Review article: percutaneous treatment of hepatocellular carcinoma

In early stage hepatocellular carcinoma (HCC), liver transplantation, surgical resection and percutaneous techniques are classified as radical treatments, and may be offered to about 25% of all patients with HCC evaluated in referral centres. The restricted inclusion criteria for surgical resection and the shortage of liver donors for transplantation have stimulated an increasing demand for minimally invasive treatments able to achieve effective and reproducible percutaneous tumour ablation, with less associated morbidity and lower cost than other interventions. Among percutaneous techniques, ethanol injection has proven to be highly effective in single HCC up to 3 cm, with a rate of complete response of 80%, being well tolerated and with a limited risk of minor complication. In larger and/or multinodular HCC the efficacy is reduced to 50% of complete response in nodules between 3 and 5 cm, and to lower rate in larger tumours. Alternative options to ethanol injection have been recently proposed, including radiofrequency, microwave and laser thermal ablation, aimed to extend the necrotic area thus improving the rate of complete response. To date, radiofrequency is the most used technique, with a reported rate of complete response of 90-98% in nodules smaller than 3 cm, and with the advantage of fewer sessions, otherwise counteracted by a higher rate of side-effects. Microwave and laser are promising technologies, but only few clinical data are available. Randomized controlled trials are needed in order to assess treatment response, long-term survival, rate of complication and cost-efficacy of newer technologies in comparison to ethanol injection.     

Predictors of gastroduodenal erosions in patients taking low-dose aspirin

Background  Gastroduodenal ulcers are common in patients taking low-dose aspirin. However, the factors predisposing to mucosal erosions, the precursor lesions, are not well known.
Aims  To examine the potential risk factors for the development of erosions in patients chronically taking low-dose aspirin.
Methods  Patients included were taking aspirin 75–325 mg daily for >28 days. Exclusion criteria included use of nonsteroidal anti-inflammatory and ulcer-healing drugs. Demographic data were collected at baseline, prior to endoscopy to determine the frequency and number of erosions and Helicobacter pylori status. In those without ulcer or other exclusions, endoscopy was repeated at 3 months.
Results  Fewer patients had gastric erosions if they were H. pylori +ve (48.5% vs. 66.4% in H. pylori −ve patients at baseline, P  = 0.17; 40.0% vs. 64.1% at 3 months, P  = 0.029). If gastric erosions were present, they were also less numerous in H. pylori +ve patients (3.61 ± 0.83 vs. 4.90 ± 0.53 at baseline, P  = 0.026; 2.17 ± 0.68 vs. 5.68 ± 0.86 at 3 months, P  = 0.029). There was a trend (0.1 >  P  > 0.05) for more gastric erosions in those taking >100 mg/day aspirin. Males had more duodenal erosions at baseline (25.2% vs. 7.5%, P  = 0.016). Patient age did not affect the presence or number of erosions. H. Pylori was not significantly associated with duodenal erosion numbers.
Conclusions  Helicobacter pylori infection may partially protect against low-dose aspirin-induced gastric erosions; damage to the stomach appears weakly dose-related; and older age does not increase the risk of erosions.     

微波凝固及醋酸注射治疗兔肝VX_2肿瘤的实验对照研究

目的　探讨微波凝固及醋酸注射治疗肝肿瘤的效果 ,并将二者进行对照研究。方法　将 18只 2 0个 VX2 兔肝癌结节随机分为两组 :微波治疗组与醋酸治疗组。微波治疗组 :肿瘤直视下将微波针斜形尽量插入肿瘤中心 ,微波辐射每次 6 0 W× 12 0 s。醋酸治疗组 :超声检测瘤灶 ,沿已选择好的路径用抽有 70 %醋酸的注射器针头经皮经肝穿刺肿瘤 ,待荧光屏上观察到针尖位于肿块中心时 ,随即在 2 0～ 30 s内匀速注入适量醋酸。每个瘤灶注射 1次 ,注射剂量为 1～ 1.5 m L ,平均 1.2 5 m L ;每 1.0 cm瘤灶直径注射量平均为 0 .8m L。治疗后 10～ 15 m in后行能量多普勒声学造影 (levovist)评价其疗效。随机抽取各阶段标本行常规病理光镜检查。结果　醋酸瘤内注射 2 4h后 8个结节肿瘤细胞发生完全凝固性坏死 ,2个结节肿瘤原发灶大部分发生变性及凝固性坏死 ,边缘有少量肿瘤残存。微波治疗 2 4h后 ,10个肿瘤结节均呈不完全坏死 ,2周后 9个肿瘤结节显示为完全坏死。结论　醋酸治疗后即刻、2 4h肿瘤坏死程度明显强于微波治疗组。但醋酸弥散性强 ,疼痛剧烈 ,凝固范围不固定 ;微波热场分布均匀 ,凝固范围稳定可靠     

Clinical trial: a randomized controlled cross-over study of flupenthixol + melitracen in functional dyspepsia

Background  Functional dyspepsia is a prevalent condition associated with diminished quality of life (QoL) and high economic burden.
Aim  To study the efficacy of a combination of flupenthixol and melitracen (F + M) with anxiolytic and antidepressant properties in functional dyspepsia using a randomized controlled cross-over design.
Methods  Patients met the Rome III criteria for functional dyspepsia and a validated questionnaire was used to exclude those with anxiety or depression. Moreover, patients had to have failed a trial of acid-suppressive therapy and Helicobacter pylori eradication when positive. End points included subjective global symptom relief and QoL assessed by the Nepean Dyspepsia Index (NDI).
Results  Twenty-five patients (14 females, 11 males; mean age = 34.3 ± 9.9 years) were enrolled and 24 completed the 8-week study. There was a significant improvement in subjective global symptom relief with F + M vs. placebo (ITT: 73.9% vs. 26.1%, P  = 0.001) and a significant drop in the NDI score vs. placebo (ITT: −9.0 ± 11.9 vs. −2.4 ± 8.9, P  = 0.03). No difference was noted whether the initial treatment was F + M or placebo. No significant side effects were noted.
Conclusions  A combination of F and M is safe and effective in the short-term treatment of functional dyspepsia. F + M is associated with significant improvement in QoL independent of the presence of anxiety or depression.     

Clinical trial: music reduces anxiety levels in patients attending for endoscopy

Background  Patients attending for endoscopy are generally anxious and worried.
Aims  To examine whether music reduced anxiety levels in patients attending for endoscopic procedures.
Methods  Prospective randomized controlled trial of 180 patients (M:F 81:99). The effect of age (≤ or >51 years) and procedure (gastroscopy or flexible sigmoidoscopy/colonoscopy) on anxiety levels (state-trait anxiety inventory) on arrival in the unit and immediately before the endoscopy procedure, after listening to music or no music (control group) for the same period.
Results  At baseline, anxiety levels were not influenced by age (≤51 years, n  = 56:42.21 ± 9.18; >51 years, n  = 124:39.99 ± 10.13 ( P  = 0.15) or procedure: gastroscopy, n  = 87:39.43 ± 9.9, flexible sigmoidoscopy/colonoscopy: n  = 93:41.86 ± 9.75 ( P  = 0.98). No difference was found in anxiety scores in the control group ( n  = 88) at baseline and immediately pre-endoscopy ( P  = 0.243), but music led to a significant reduction in anxiety scores ( n  = 92), which was maintained for all age groups irrespective of procedure (all P  < 0.0001).
Conclusions  Anxiety levels in patients attending for endoscopy were not influenced by age or procedure, but were significantly reduced by listening to music compared to controls. The availability of music within the endoscopy unit is a simple strategy that will improve the well-being of patients.     

Gut wall metabolism of verapamil in older people: effects of rifampicin-mediated enzyme induction

Aims To investigate prehepatic metabolism of verapamil and its inducibility by rifampicin in older subjects.
Methods Eight older subjects (67.1±1.2 years mean±s.d.) received racemic, unlabelled verapamil orally for 16 days (120  mg twice daily). Rifampicin (600  mg daily) was coadministered from day 5 to 16. Using stable isotope technology (i.e. intravenous coadministration of 10  mg deuterated verapamil) during verapamil steady-state without (day 4) and with rifampicin (day 16) bioavailability, prehepatic and hepatic extraction of verapamil were determined. The effects of verapamil on AV-conduction were measured by the maximum PR interval prolongation (%).
Results Bioavailability of the cardiovascularly more active S-verapamil decreased from 14.2±4.3% on day 4 to 0.6±0.5% on day 16 ( P <0.001). As a consequence, effects of orally administered verapamil on the AV-conduction were nearly abolished (14.4±9.4% vs 2.7±2.6%, P <0.01). This could be attributed to a considerable increase of prehepatic extraction during treatment with rifampicin (41.7±22.1% vs 91.6±6.6%, P <0.01) and to a minor extent to induction of hepatic metabolism (73.7±9.4% vs 91.6±5.3%, P <0.01).
Conclusions Prehepatic metabolism of verapamil occurred in the group of older people investigated. Induction of gut wall metabolism most likely was the major reason for the loss of verapamil effect during treatment with rifampicin in this group of older subjects.     

无水酒精注射术联合射频消融术与单纯射频消融术治疗小肝癌的疗效比较

目的比较无水酒精注射术(PEI)联合射频消融术(RFA)治疗方案与单纯RFA治疗小肝癌的疗效。方法回顾分析我院2006年1月～2008年1月进行的68例小肝癌射频消融治疗患者的临床资料。68例中37例行PEI联合RFA术,31例行单纯RFA术。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 PEI联合RFA组肿瘤完全消融率91.89%,局部复发率10.81%,局部复发时间(14.22±3.48)月,1、2、3年的生存率分别为89.19%、81.08%和72.97%。单纯RFA组肿瘤完全消融率70.97%,局部复发率32.26%,局部复发时间(9.15±2.68)月,1、2、3年的生存率87.10%、77.42%和48.39%。PEI联合RFA组在肿瘤完全消融率、局部复发率、复发时间、术后3年生存率方面好于单纯RFA组。结论 PEI联合RFA治疗小肝癌疗效优于单纯RFA治疗,在小肝癌的治疗中有重要临床应用价值。     

Clinical trial: protective effect of a commercial fish protein hydrolysate against indomethacin (NSAID)-induced small intestinal injury

Background  A partially hydrolysed and dried product of pacific whiting fish is marketed as a health food supplement supporting 'intestinal health'.
Aim  To examine whether the partially hydrolysed and dried product of pacific whiting fish influenced the small intestinal damaging side effects of the nonsteroidal anti-inflammatory drug, indomethacin.
Methods  Eight human volunteers completed a double-blind, placebo-controlled, crossover protocol of clinically relevant dose of indomethacin (50 mg t.d.s. p.o. for 5 days) with 7 days of fish hydrolysate or placebo starting 2 days prior to indomethacin. Changes in gut permeability were assessed using 5 h urinary lactulose:rhamnose (L/R) ratios.
Results  Fish hydrolysate given alone did not affect permeability. In the main study ( n  = 8), baseline values were similar for both arms (0.28 ± 0.05 and 0.35 ± 0.07). Administration of indomethacin (+placebo) caused a fivefold rise in L/R ratios (increasing to 1.54 ± 0.35), whereas L/R ratios in the same subjects ingesting indomethacin + fish hydrolysate was only 0.59 ± 0.14 ( P  < 0.01 vs. indomethacin alone). Dyspeptic symptoms occurred in four of eight subjects taking indomethacin alone, but zero of eight when hydrolysate was co-administered.
Conclusion  Natural bioactive products (nutriceuticals), such as fish hydrolysates, may provide a novel approach to the prevention and treatment of NSAID-induced and other gastrointestinal injurious conditions.     

Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol + ligation vs. hepatic venous pressure gradient-guided pharmacological therapy

Background  Hepatic venous pressure gradient (HVPG) monitoring of therapy to prevent variceal rebleeding provides strong prognostic information. Treatment of nonresponders to β-blockers ± nitrates has not been clarified.
Aim  To assess the value of HVPG-guided therapy using nadolol + prazosin in nonresponders to nadolol + isosorbide-5-mononitrate (ISMN) compared with a control group treated with nadolol + ligation.
Methods  Cirrhotic patients with variceal bleeding were randomized to HVPG-guided therapy ( n  = 30) or nadolol + ligation ( n  = 29). A Baseline haemodynamic study was performed and repeated within 1 month. In the guided-therapy group, nonresponders to nadolol + ISMN received nadolol and carefully titrated prazosin and had a third haemodynamic study.
Results  Nadolol + prazosin decreased HVPG in nonresponders to nadolol + ISMN ( P  < 0.001). Finally, 74% of patients were responders in the guided-therapy group vs. 32% in the nadolol + ligation group ( P  < 0.01). The probability of rebleeding was lower in responders than in nonresponders in the guided therapy group ( P  < 0.01), but not in the nadolol + ligation group ( P  = 0.41). In all, 57% of nonresponders rebled in the guided-therapy group and 20% in the nadolol + ligation group ( P  = 0.05). The incidence of complications was similar.
Conclusions  In patients treated to prevent variceal rebleeding, the association of nadolol and prazosin effectively rescued nonresponders to nadolol and ISMN, improving the haemodynamic response observed in controls receiving nadolol and endoscopic variceal ligation. Our results also suggest that ligation may rescue nonresponders.     

Rapid protection of the gastroduodenal mucosa against aspirin-induced damage by rabeprazole

Background  The ability of a proton pump inhibitor to reduce or prevent NSAID-induced gastroduodenal damage during the first 24 h has not been tested.
Aim  To determine, whether oral rabeprazole, administered 5 h before the initiation of therapeutic dosing of aspirin protects the gastroduodenal mucosa.
Methods  Normal subjects were randomized into two groups – one received rabeprazole, 20 mg at 07:00 hours and the other placebo, before initiation of aspirin 650 mg at 12:00 hours, and then q4 h for 3 days. Upper endoscopic examinations were performed on all subjects at baseline, 24 and 72 h after initiation of aspirin. Gastroduodenal mucosal damage was scored.
Results  Thirty subjects were compliant with study medications and underwent three endoscopic examinations. Salicylate concentrations were similar for the placebo and the rabeprazole groups at all times. On rabeprazole, the Lanza scores were significantly lower compared with placebo at 24 h (1.3 ± 0.26 vs. 2.1 ± 0.26, P  < 0.05) and at 72 h (1.3 ± 0.29 vs. 2.3 ± 0.28, P  < 0.05). Gastric antral erosion counts were less with rabeprazole than placebo at 24 (4.1 ± 1.3 vs. 7.6 ± 2.0, P  > 0.05) and 72 h (5.3 ± 1.8 vs. 8.0 ± 1.5; P  > 0.05).
Conclusions  Rabeprazole, initiated 5 h before the start of therapeutic dosing with aspirin, decreased Lanza scores and antral erosion counts at 24 h. These findings suggest that prophylaxis with rabeprazole could start concurrently with aspirin administration.     

Clinical Trial: High-dose furosemide plus small-volume hypertonic saline solutions vs. repeated paracentesis as treatment of refractory ascites

Background  In patients with cirrhosis, ascites is defined as refractory when it cannot be mobilized or recurs early in standard diuretic therapy.
Aim  To compare the safety and efficacy of intravenous high-dose furosemide + hypertonic saline solutions (HSS) with repeated paracentesis in patients with cirrhosis and refractory ascites.
Patients and methods  Eighty-four subjects (59/25 M/F) with cirrhosis, mostly of viral aetiology, admitted for refractory ascites, were randomly assigned to receive furosemide (250–1000 mg/bid i.v.) plus HSS (150 mL H₂O with NaCl 1.4–4.6% or 239–187 mEq/L) (60 patients, Group A) or to repeated paracentesis and a standard diuretic schedule (24 patients, Group B).
Results  During hospitalization, Group A patients had more diuresis (1605 ± 131 mL vs. 532 ± 124 mL than Group B patients; P  < 0.001) and a greater loss of weight at discharge (−8.8 ± 4.8 kg vs. −4.5 ± 3.8 kg, P  < 0.00). Control of ascites, pleural effusions and/or leg oedema was deemed significantly better in Group A.
Conclusions  This randomized pilot study suggests that HHS plus high-dose furosemide is a safe and effective alternative to repeated paracentesis when treating hospitalized patients with cirrhosis and refractory ascites. Larger studies will be needed to evaluate long-term outcomes such as readmission and mortality.     

Comparison of racecadotril and loperamide in children with acute diarrhoea

Methods A multicentre, parallel-group, double-blind, double-placebo study was carried out to compare the efficacy, tolerability, and safety of racecadotril and loperamide in children aged 2 to 10 years who were suffering from acute diarrhoea. Patients received racecadotril (1.5 mg/kg) or loperamide (0.03 mg/kg) three times daily plus matching placebo until recovery. Fifty-two children received racecadotril and 50 loperamide.
Results Patients on racecadotril passed a mean (± S.E.M.) of 2.7 ± 0.4 stools before recovery compared with 2.1 ± 0.4 stools for loperamide. The duration of diarrhoea was similar with both treatments. The incidence of adverse events was lower with racecadotril than with loperamide (11.5% vs. 22%), and significantly more patients on loperamide suffered from constipation (58% vs. 36.5%; P  = 0.03). Moreover, significantly more children receiving loperamide required concomitant medication during the study (38% v 19.2%; P  = 0.047). Measurement of abdominal circumference at the final consultation, 6 days after entry to the study, revealed no significant differences between treatments.
Conclusions Racecadotril and loperamide were equally effective in treating acute diarrhoea in these children, and racecadotril had a superior tolerability and safety profile.     

Epidermoid anal cancer prognosis comparison among HIV+ and HIV− patients

Background  Previous studies suggest a poor prognosis of epidermoid anal cancer in HIV+ patients.
Aim  To investigate the long-term outcome of epidermoid anal cancer in HIV+ and HIV− patients in the highly active antiretroviral treatment (HAART) era.
Methods  We included all patients with epidermoid anal cancer referred to six hospitals from 1998 to 2004.
Results  In all, 151 patients (44 HIV+, 107 HIV−) were reviewed retrospectively for 27 (median of 16–44) months. HIV+ patients were male (100% vs. 27%, P  < 0.001) and younger (45 vs. 62 years old, P  < 0.001) than HIV− patients. No significant differences were observed in the tumour stage, pelvic radiotherapy dose or concomitant chemotherapy, according to the HIV status. After chemoradiotherapy, similar numbers of HIV+ and HIV− patients had grade III-IV toxicity. A complete response was obtained in 82% and 75% (N.S.) of cases, respectively. The disease-free survival rates were 77% and 67% (N.S.) and the overall survival rates were 85% and 84% (N.S.), respectively, after 3 years of follow-up. Duration of HIV infection, viral load and CD4 count had no effect on the survival rate of HIV+ patients with EAC.
Conclusions  The clinical outcome of HIV+ patients with epidermoid anal cancer is similar to that of HIV− patients. Therefore, the same therapeutic guidelines should be applied to both populations.     

Clinical trial: effectiveness of chewing-gum in accelerating capsule endoscopy transit time--a prospective randomized, controlled pilot study

Background  Capsule endoscopy (CE) fails to reach the caecum in approximately 20% of patients. Data suggest that chewing-gum, simulating sham feeding, provokes the cephalic phase of gastrointestinal (GI) motor response and may increase GI motility.
Aim  To determine whether chewing-gum increases the ability of CE reaching the caecum.
Methods  Prospective, randomized, single-blinded controlled trial. Ninety-three consecutive patients were randomized either to use chewing-gum ( n  = 47) or not ( n  = 46). All patients received the identical bowel preparation. Patients chewed one piece of gum for approximately 30 min every 2 h. Two blinded gastroenterologists examined all studies. The number of CE that reached the caecum within 8-h, gastric transit time (GTT) and small bowel transit time (SBTT) were evaluated in all patients.
Results  The CE percentage passed into the caecum was higher in the chewing-gum group compared with those in the other (83.0% vs. 71.7% respectively, P  = 0.19). Both GTT and SBTT were significantly shorter in the chewing-gum vs. control group [40.8 min (interquartile range: 21–61 min) vs. 56.1 min (interquartile range: 22–78 min) ( P  = 0.045) and 229.1 min (interquartile range: 158–282 min) vs. 266.2 min (interquartile range: 204–307 min) ( P  = 0.032) respectively]. Chewing-gum did not adversely affect CE image quality.
Conclusions  Chewing-gum significantly reduces GTT and SBTT during CE. Its use may improve the likelihood of the capsule reaching the caecum without affecting CE image quality.