Inhibition of Gastric Secretion Relieves Diarrhea and Postprandial Urgency Associated with Irritable Bowel Syndrome or Functional Diarrhea

Five patients with gastroesophageal refluxdisease (GERD), who also had chronic functional diarrheaand postprandial urgency, unexpectedly noted rapidrelief of their diarrhea and urgency when they took lansoprazole for their heartburn. To determineif this surprising result was not fortuitous, all 20patients seen during the next six months for chronicdiarrhea and postprandial urgency due to irritable bowel syndrome (IBS) or functional diarrheawere treated with inhibitors of gastric secretion: 14with proton-pump inhibitors and 6 with H₂blockers. All patients had rapid, marked improvement. Usually within three days, their symptomsabated and they usually had one to three formed stoolsper day. Relief continued during the one to six monthsthey were followed on therapy. Five patients stopped therapy, had recurrent diarrhea, and rapidrelief upon resuming therapy. Thus, inhibition ofgastric secretion effectively controls the diarrhea andpostprandial urgency associated with IBS or functional diarrhea, probably by diminishing thegastrocolic or gastroenteric reflex.     

Rehabilitation of the tympanomastoid cavity in Canal Wall Down procedures

During 1980 to 2004, 1602 Canal Wall Down (CWD) procedures was performed of which 978 had primary surgery and 624 were revision cases. We have highlighted various methods for total clearance of disease process from the tympanomastoid area, making of a smooth cavity, augmentation of middle ear space for better functional results, inlay temporalis fascia grafting, ossiculoplasty with live tissue grafts, natural obliteration of the cavity and meatoplasty. Healing of cavity and tympanic membrane (TM) graft was achieved in 1548 (94.2%) of cases. Revision surgery was performed in 32 cases for recurrence or residual cholesteatoma, mostly in the attic and middle ear. Persisting discharge was present in 12 cases. Serviceable hearing (airbone (A–B) gap closure up to 20 dB) was achieved in 1017 (63.5%) cases. Hearing was worse than pre-operative level in 154 (9.6%) cases. There was no improvement in hearing in 397 (24.8%) cases. Serviceable hearing was obtained after second stage ossiculoplasty in 34 (2%) cases.     

Outcomes of open transverse abdominis release for ventral hernias: a systematic review,meta-analysis and meta-regression of factors affecting them

Hernia - The primary objectives were to evaluate Surgical Site Occurrences (SSO) and Surgical Site Occurrences requiring procedural Intervention (SSOPI) after open transversus abdominis release and...     

Correlation of left atrial appendage histopathology,cardiac rhythm,and response to maze procedure in patients undergoing surgery for rheumatic valvular heart disease

Introduction All patients with atrial fibrillation (AF) do not revert to sinus rhythm (SR) with hemodynamic correction and procedures to restore SR. We co-relate left atrial appendage (LAA) histopathology and cardiac rhythm, and its response to maze procedure, in patients undergoing surgery for rheumatic valvular heart disease. Methods LAA histopathology was studied in two groups of 25 patients each, with pre-operative sinus rhythm (Group A) and atrial fibrillation for >3 months (Group B). 16 patients of Group B underwent modified maze procedure. LAA histopathology was classified in three grades based on endocardial inflammation and myofibril hypertrophy. The rhythm of all patients was observed post-operatively. Results In group A, 20 (80%) of 25 patients had Grade I–II changes in LAA, and all remained in SR. 5 (20%) patients had grade III changes, of which 2 (40%) went into AF on follow up. In group A, of 17 (68%) patients with stenotic or mixed mitral valve lesions, 15 (88%) had grade I–II changes in LAA. While of 8 (32%) patients with MR, 3 (37.5%) had grade III changes. In group B, 13 (52%) of 25 patients had grade I–II changes, while 12 (48%) had grade III changes in LAA. Of 14 (56%) patients with stenotic or mixed mitral valve lesions, 13 (92%) had grade I–II changes in LAA. While 9 (81%) of 11 patients with MR had grade III changes in LAA. Of the 16 patients in group B undergoing maze, 9 (56%) patients of whom 8 (88%) had grade I–II changes converted to SR, whereas 7 (44%) patients, all with grade III changes remained in AF. Conclusions Patients in AF and with MR have predominantly grade III changes in LAA. Patients with grade III changes on follow up have tendency to remain in AF even after modified maze procedure. Presented at the 50^th Annual Meeting of IACTS, New Delhi, Feb., 2004.     

Analysis of a second-generation tetracycline antibiotic minocycline in human plasma by LC-MS/MS

A simple, selective and sensitive LC-MS/MS assay has been developed for the determination of minocycline in human plasma. Plasma samples were prepared by protein precipitation, followed by chromatographic separation on a HyPURITY? C8 (100 mm × 4.6 mm, 5 μm) column under isocratic conditions. The LOD and LLOQ of the method were 0.50 and 20.0 ng/ml, respectively. The intra-batch and inter-batch precision (% coefficient of variation) across quality control levels was less than 8.0%. For a set of incurred samples the percentage change in concentration was within ± 9.0%. The method was successfully applied to a bioequivalence study of 135 mg minocycline tablet formulation in 14 healthy Indian males. The reproducibility in the measurement of study data was demonstrated by incurred sample reanalysis.     

Phosphatidylinositol‐3‐kinase pathway aberrations in gastric and colorectal cancer: Meta‐analysis,co‐occurrence and ethnic variation

Inhibition of the phosphatidylinositol‐3‐kinase (PI3K) signaling pathway is a cancer treatment strategy that has entered into clinical trials. We performed a meta‐analysis on the frequency of prominent genetic (PIK3CA mutation, PIK3CA amplification and PTEN deletion) and protein expression (high PI3K, PTEN loss and high pAkt) aberrations in the PI3K pathway in gastric cancer (GC) and colorectal cancer (CRC). We also performed laboratory analysis to investigate the co‐occurrence of these aberrations. The meta‐analysis indicated that East Asian and Caucasian GC patients differ significantly for the frequencies of PIK3CA Exon 9 and 20 mutations (7% vs. 15%, respectively), PTEN deletion (21% vs. 4%) and PTEN loss (47% vs. 78%), while CRC patients differed for PTEN loss (57% vs. 26%). High study heterogeneity (I² > 80) was observed for all aberrations except PIK3CA mutations. Laboratory analysis of tumors from East Asian patients revealed significant differences between GC (n = 79) and CRC (n = 116) for the frequencies of PIK3CA amplification (46% vs. 4%) and PTEN loss (54% vs. 78%). The incidence of GC cases with 0, 1, 2 and 3 concurrent aberrations was 14%, 52%, 27% and 8%, respectively, while for CRC it was 10%, 60%, 25% and 4%, respectively. Our study consolidates knowledge on the frequency, co‐occurrence and clinical relevance of PI3K pathway aberrations in GC and CRC. Up to 86% of GC and 90% of CRC have at least one aberration in the PI3K pathway, and there are significant differences in the frequencies of these aberrations according to cancer type and ethnicity.     

Office management of the patient with chronic cough

Chronic cough is a common complaint in the ambulatory setting and can result in significant compromise in quality of life and, uncommonly, is a presenting symptom of serious or life-threatening disease. Although there are many potential causes, an organized approach to diagnosis that may include therapeutic trials of select medications can establish the diagnosis in over 90% of presenting patients. Management hinges on accurate etiologic diagnosis. Consultation with a pulmonologist, otolaryngologist, or allergist is indicated in selected cases where diagnosis is unclear or specific therapy is mandated.