Does the pancreas move with respiration?

BACKGROUND AND AIM: The pancreas is a retroperitoneal organ and has been classically considered to be immobile on respiration. Recent radiological studies assessing the mobility of the pancreas have challenged this traditional concept. The present study was conducted to assess the movement of pancreas with respiration using fluoroscopy, a simple and inexpensive method. METHODS: Patients with chronic pancreatitis who had either pancreatic calcification evident on fluoroscopy or an indwelling pancreatic duct stent were studied. The movement of the pancreas was assessed under fluoroscopy by measuring the displacement of the stent or calcification in relationship to the spine in maximum inspiration followed by maximum expiration. RESULTS: Twenty-two patients (mean age 35.45 + or - 11.29 years, 17 men) with chronic pancreatitis were included in the study. Ten patients had pancreatic calcification and 12 had an indwelling pancreatic duct stent (two in the dorsal duct, 10 in the ventral duct). In all patients, the pancreas moved downward in the craniocaudal direction on deep inspiration. Pancreatic excursion from maximum inspiration to maximum expiration ranged from 0.1 to 3.4 cm. In addition, a medial movement of the head of pancreas was also noted in most of the patients. On univariate analysis, no association was found between the range of movement and the age or sex of the patient, duration or etiology of disease, presence or absence of calcification, severity of ductal changes of chronic pancreatitis and the length or diameter of the pancreatic stent placed. CONCLUSION: The pancreas moves craniocaudally with respiration and the head moves medially on inspiration.     

Clinical Observation on the Aggressive Lipid-lowering Treatment with Simvastatin on the Aged Patients with Coronary Artery Disease

Objectives To find out the efficient dose and safety of simvastatin (Zocor) on the aged patients with coronary artery disease (CAD) for aggressive lipid-lowering treatment. Methods Select 95 aged patients with CAD combined with primary hyperlipemia and give them 20mg/day of simvastatin for treatment. According to the therapeutic target of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) regulate the dosage of simvastatin in follow-up. Observe 12-18 months. Results After treatment, the TC, LDL-C and triglycerides(TG) of the patients reduced by 40%，52% and 26% respectively, while there was no significant change in high-density lipoprotein cholesterol (HDL-C). The apolipoprotein A1 arose by 14.4%, while the apolipoprotein B lowered by 25.0%. The ratio of LDL-C to HDL-C was reduced to 1.96. In the 6^th month, the 12^th month and the 18th month, respectively, 86%, 93% and 95% of the patients took 10mg/day of simvastatin and the result was their TC≤140mg/dL(3.7mmol/L) and LDL-C≤70mg/dL(1.8mmol/L).There was no special side-effect. Multi-factor analysis indicated the age of the patients was a significant factor affecting the adjustment of the dosage of simvastatin.Conclusions The therapeutic result of simvastatin on the aged patients with CAD for aggressive lipid-lowring treatment is definite, safe and the dose is lower as well.     

Microproteinuria in patients with inflammatory bowel disease： Is it associated with the disease activity or the treatment with 5-aminosalicylic acid？

AIM: To investigate whether microproteinuria in patients with inflammatory bowel disease (IBD) is associated with the disease activity or the treatment with 5-aminosalicylic acid (5-ASA). METHODS: We prospectively studied microproteinuria in 86 consecutive patients with IBD, 61 with ulcerative colitis (UC) and 25 with Crohn's disease (CD), before as well as 2 and 6 months after their inclusion in the study. Forty-six patients received 5-ASA for a period of 28.8 months (range 1-168 mo). Microalbuminuria (mALB) and urine levels of the renal tubular proteins beta2-microglobulin (beta2mGLB) and beta-N-acetyl-D-glucosamidase (beta-NAG) as well as the creatinine clearance were determined in a 12-h overnight urine collection. Tumor necrosis factor-alpha (TNF-alpha) serum levels were also measured. RESULTS: A total of 277 measurements (194 in UC patients and 83 in CD patients) were performed. The prevalence of abnormal microproteinuria in UC and CD patients was 12.9% and 6.0% for mALB, 22.7% and 27.7% for beta2mGLB, and 11.3% and 8.4% for beta-NAG, respectively. mALB was not associated with IBD activity. Beta2mGLB and beta-NAG urine levels were correlated to UC activity (UCAI: P<0.01; UCEI: P<0.005). mALB in UC patients and beta-NAG urine levels in CD patients were related to TNF-alpha serum levels. An association was noticed between microproteinuria and smoking habit. Treatment with 5-ASA was not correlated to the severity of microproteinuria or to the changes of creatinine clearance. CONCLUSION: Microproteinuria is mainly associated with UC and its activity but not affected by 5-ASA.     

Enteropathic arthritis: how do the joints talk with the gut?

Enteropathic arthritis is a label for conditions in which gut pathology is believed to be of pathogenic importance for the developing joint disease. Impaired barrier function, as well as immunogenetic mechanism, are implicated. Recent publications have highlighted strong new support for the homing of lymphocytes from the gut mucosa to joint tissue, persistence of antigen- and cytokine-based immune deficiency. A convincing argument was made for the interesting observation that two distinct types of joint involvement with different class II HLA backgrounds occur in patients with inflammatory bowel disease. A new mechanism implicating dimeric HLA-B27 heavy chains in the pathogenesis of enteropathic arthritis is also presented. Despite evidence for persisting antigen presence, antimicrobial therapy seems ineffective in reactive arthritis.     

Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?

PURPOSE: Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being "known as a person" and receipt of highly active antiretroviral therapy (HAART), adherence to HAART, and health outcomes among patients with HIV. STUDY DESIGN: Cross-sectional analysis. SUBJECTS: One thousand seven hundred and forty-three patients with HIV. MEASUREMENTS: Patient reports that their HIV provider "knows me as a person" and 3 outcomes: receipt of HAART, adherence to HAART, and undetectable serum HIV RNA. RESULTS: Patients who reported that their provider knows them "as a person" were more likely to receive HAART (60% vs 47%, P<.001), be adherent to HAART (76% vs 67%, P=.007), and have undetectable serum HIV RNA (49% vs 39%, P<.001). Patients who reported their provider knows them "as a person" were also older (mean 38.0 vs 36.6 years, P<.001), reported higher quality-of-life (mean LASA score 71.1 vs 64.8, P<.001), had been followed in clinic longer (mean 64.4 vs 61.7 months, P=.008), missed fewer appointments (mean proportion missed appointments 0.124 vs 0.144, P<.001), reported more positive beliefs about HAART therapy (39% vs 28% strongly believed HIV medications could help them live longer, P<.008), reported less social stress (50% vs 62% did not eat regular meals, P<.001) and were less likely to use illicit drugs or alcohol (22% vs 33% used drugs, P<.001; 42% vs 53% used alcohol, P<.001). Controlling for patient age, sex, race/ethnicity, quality-of-life, length of time in clinic, missed appointments, health beliefs, social stress, and illicit drug and alcohol use, patients who reported their provider knows them "as a person" had higher odds of receiving HAART (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19 to 1.65), adhering to HAART (OR 1.33, 95% CI 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% CI 1.02 to 1.41). CONCLUSIONS: We found that a single item measuring the essence of patient-centeredness-the patients' perception of being "known as a person"-is significantly and independently associated with receiving HAART, adhering to HAART, and having undetectable serum HIV RNA. These results support the hypothesis that the quality of patient-physician relationship is directly related to the health of patients.     

Is the post-transplantation treatment with AMD beneficial?

Recent data have suggested novel ways to enhance donor cell engraftment by treating transplanted recipients with CXCR4/CXCL12 inhibitors, thereby expanding the biologic potential of these molecules primarily used for mobilization purposes. We tested whether repeated pulse inhibitions of CXCR4/CXCL12 signaling using AMD, an inhibitor of CXCR4/CXCL12 signaling, would enhance engraftment in non-myeloablated murine recipients, similar to data published in a myeloablative setting. We documented an increased proportion of circulating neutrophils (both donor- and host-derived) in the AMD-treated group, but this increase was not kinetically influenced by AMD treatment and multilineage engraftment was not enhanced. Although our results with neutrophils are similar to recent clinical data in neutropenic patients chronically treated with AMD, the absence of multilineage engraftment diverges from data in myeloablated recipients. We conclude that pulses of mobilization by AMD post transplantation do not enhance multilineage engraftment.     

Is the supplementation with antioxidants effective in the treatment of atherosclerosis?

Results from experimental and epidemiologic studies suggest an influence of oxidative stress on development and progression of atherosclerosis in man. Prospective endpoint studies failed to support this hypothesis. The current literature is summarized in this review.     

Insufficiency fracture at the distal diaphysis of the radius after synovectomy combined with the Sauvé-Kapandji procedure in a patient with rheumatoid arthritis

We report here a rare case of insufficiency fracture at the distal diaphysis of the radius in a patient with rheumatoid arthritis (RA) after synovectomy combined with the Sauvé-Kapandji procedure. A 71-year-old woman who had been diagnosed with RA had been consecutively treated with several disease-modifying antirheumatic drugs. She had undergone synovectomy of the right wrist combined with the Sauvé-Kapandji procedure, due to a tendon rupture, 2 years before the current presentation (first visit). Although she had not experienced any recent trauma, the wrist pain had increased after she had lifted up the bedding at the funeral of her friend about 1 month prior to her first visit. Radiographs of her right wrist taken at the second visit showed a fracture at the distal diaphysis of the radius at the level of the excision osteotomy of the distal ulna; however, no displacement of the distal fragment was observed. We immobilized her forearm in a long-arm cast. However, after 3 weeks of cast immobilization, a displacement of the distal fragment was observed. A manual reduction of the displacement was performed and the arm was again immobilized in a long-arm cast. However, 1 week later, a displaced distal fragment was again observed. Subsequently, she received an open reduction and internal fixation using a volar locking plate and screws with an autologous iliac crest bone graft. Bone union was completed by 8 months following the operation.