Gastric ulceration as a complication of hepatic artery infusion chemotherapy

Based upon the cases reported in this paper and upon a literature review encompassing 1,783 patients having received HAIC, it is our opinion that upper gastrointestinal tract ulceration is a potentially significant complication of hepatic artery infusion chemotherapy. In addition, we believe that the mechanism responsible for HAIC-induced ulceration often involves direct perfusion of the gastric arterial supply with chemotherapeutic agents. The occurrence of ulcerations in patients with surgically placed catheters is disconcerting, and does not allow for any apparent easy method of alleviating HAIC-induced ulceration. Clinicians should be alerted to the possibility of gastric and duodenal ulceration in patients treated with HAIC, and should afford particular attention to gastrointestinal symptoms during hepatic artery infusion chemotherapy.     

Endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis

Over a five and one half year period, four of nine patients with endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis following intestinal perforation. Two patients had colonic perforation associated with diverticular disease, one necrosis of the terminal ileum, and one acute appendicitis. Two of the patients died subsequent to these complications. The survivors had early transfer to haemodialysis. In contrast, over the same period, only two of 125 patients with renal failure due to other causes and managed by CAPD had acute intestinal perforation. In both cases this was associated with acute appendicitis. Both patients survived. All episodes of peritonitis in CAPD patients with polycystic kidneys demand very close monitoring, cessation of CAPD, and early surgical intervention. CAPD is relatively contraindicated in such patients.     

Effect of gastric mucosal injury on ornithine decarboxylase in young and aged rats

The present investigation examines the changes in ornithine decarboxylase (ODC) activity, level of the enzyme, and the expression of its gene in gastric mucosa of young (4-month) and aged (24-month) Fischer-344 male rats 6 h after intragastric administration of either 2 M NaCl (1 ml/130 g b.w.) or an equivalent volume of water (controls). In addition, electronmicroscopy was performed to evaluate the ultrastructural changes in the gastric mucosa. Although administration of 2 M NaCl virtually eliminated the surface epithelium in both young and aged rats, the extent to injury in older animals extended beyond the surface epithelium. In aged rats, epithelial cells in the deeper parts of the gastric glands demonstrated severe swelling with vacuolization and disintegration of the cell organelles, with dying and dead cells. Basal gastric mucosal ODC activity (data from the controls) in aged rats was found to be 118% (p less than 0.001) above the young animals. This was also associated with similar increases in the concentration of ODC (as determined by Western-blot analysis) and a steady-state rise in ODC mRNA. Intragastric administration of 2 M NaCl (which caused gastric mucosal injury) resulted in a 625% increase in mucosal ODC activity in young rats, but in aged rats it produced a 112% increase when compared with the corresponding controls. In young rats, the increase in gastric mucosal ODC activity after injury was also associated with about a 2-fold rise in the enzyme protein concentration and a 4-fold increase in steady-state ODC mRNA levels. In contrast, gastric mucosal injury in aged rats, which resulted in a 112% increase in ODC activity, produced about a 30% reduction in the concentration of ODC and a 15-20% reduction in steady-state mRNA levels, when compared with the respective controls. The current data demonstrate that aging is associated with decreased responsiveness of gastric mucosal ODC to injury which may in part be responsible for diminished regenerative capacity of the gastric mucosa in aged animals. Furthermore, in aged rats the injury-induced stimulation of mucosal ODC activity is not associated with increased activation of its gene.     

Multilocus Analyses Reveal Involvement of the ESR1, ESR2, and FSHR Genes in Migraine

Objective.— Female hormone genes have been investigated in migraine in recent years. Research in this field has been controversial, especially in regard to ESR1 gene findings. None of the reports have yet to approach the problem from a multigenic point of view. Methods.— We investigated 5 polymorphisms implicated in female hormone metabolism (FSHR, CYP19A1, ESR1, NRIP1, and ESR2) in a cohort of 730 subjects matched for age and sex. The effect of gene–gene interaction was assessed using the set association approach, and the corresponding haplotypes were studied with PM Plus software. To corroborate initial results, we analyzed the selected markers using a cohort of 134 families in which 168 trios were suitable for transmission‐disequilibrium test (TDT) analysis under the migraine with aura (MA) phenotype. Results.— A total of 356 consecutive migraine patients (198 with MA [76% females] and 158 migraine without aura [MO, 74% females], and 374 matched controls [71% females]) were genotyped. In the 2‐point analyses, the ESR1 and ESR2 polymorphisms showed nominal association under MA/MO phenotype, and this association was higher with the FSHR polymorphism in MA females (P = .004, uncorrected). Using the SUMSTAT program, we observed ESR2‐ESR1‐FSHR significant gene–gene interaction, suggesting association with the MA/MO phenotype (P = .005; P = .003 in females), and with MA alone (P = .021; P = .030 for females). We corroborated that ESR2‐ESR1‐FSHR haplotypes interacted for migraine under a model‐free hypothesis (empirical P = .010 for the whole sample; P = .001 for females), and the association was stronger for the MA phenotype alone (empirical P = 5.0e‐4, under the heterogeneity model; P = .001 for females). These results were corroborated using family‐based association approaches. We observed nominal association for ESR2 and ESR1 (P = .031 and .034, respectively) in the TDT study, and significant association for ESR1 using family‐based association test statistics. Haplotype‐TDT analyses showed further significant gene–gene interaction for ESR1‐ESR2 (global P = .009), ESR2‐FSHR (global P = .011), and nominally significant interaction for ESR2‐ESR1‐FSHR genes (global P = .037). Conclusion.— We found significant association of female hormone metabolism polymorphisms under the perspective of multigene approach.     

Anti-respiratory syncytial virus (RSV) neutralizing antibody decreases lung inflammation, airway obstruction, and airway hyperresponsiveness in a murine RSV model

Numerous studies have described a strong association between respiratory syncytial virus (RSV) infection in infancy and the development of recurrent wheezing and airway hyperresponsiveness. We evaluated the effect of an anti-RSV neutralizing monoclonal antibody (palivizumab) on different aspects of RSV disease by using a murine model. BALB/c mice were intranasally inoculated with RSV A2. Palivizumab or an isotype-matched control antibody was administered once at 24 h before inoculation, 1 h after inoculation, or 48 h after inoculation. Regardless of the timing of administration, all mice treated with the neutralizing antibody showed significantly decreased RSV loads in bronchoalveolar lavage (BAL) and lung specimens compared with those of infected controls. Pulmonary histopathologic scores, airway obstruction measured by plethysmography, and airway hyperresponsiveness after methacholine challenge were significantly reduced in mice treated with the anti-RSV antibody 24 h before inoculation compared with those for untreated controls. Concentrations of interferon-gamma, interleukin-10, macrophage inflammatory protein 1alpha, regulated on activation normal T-cell expressed and secreted (RANTES), and eotaxin in BAL fluids were also significantly reduced in mice treated with palivizumab 24 h before inoculation. This study demonstrates that reduced RSV replication was associated with significant modulation of inflammatory and clinical markers of acute disease severity and significant improvement of the long-term pulmonary abnormalities. Studies to determine whether strategies aimed at preventing or reducing RSV replication could decrease the long-term morbidity associated with RSV infection in children should be considered.