Influence of gastric mucosal status on success of stepwise acid suppressive therapy for dyspepsia

Background  The most effective initial treatment strategy of dyspepsia is still under debate. Individual biological characteristics, such as condition of gastric mucosa, might contribute to selection of the most appropriate acid suppression treatment strategy.
Aim  To assess whether pre-treatment testing of gastric mucosal status is relevant for treatment success in an RCT comparing step-up and step-down therapies in newly diagnosed dyspepsia patients.
Methods  Baseline serum samples were collected to assess gastric mucosal status using serum levels of pepsinogens-I&II, gastrin-17, and Helicobacter pylori IgA/IgG-antibodies. The 6-month treatment success was compared between step-up and step-down for patients with serum diagnoses: normal; gastritis; corpus atrophy or antrum atrophy.
Results  In all, 519 patients (M/F: 249/270, age: 47 (18–85) years, 29% H. pylori +) were randomized to step-up ( n  = 293) or step-down ( n  = 226). Normal mucosa, gastritis and corpus atrophy were diagnosed serologically in 70%, 28% and 2% of the patients, evenly distributed between the strategies ( P  = 0.65). Treatment success was achieved in respectively, 69%, 70% and 70% for the serum diagnosis groups, and did not differ between the strategies.
Conclusions  Dyspepsia treatment success could not be predicted by gastric mucosal status. Therefore, serum diagnosis of gastric mucosal status is no useful tool for patient allocation to acid suppressive treatment strategies.     

Clearance and Glomerular Localization of Preformed DNP Anti-DNP Immune Complexes

The in vivo behaviour of well-defined immune complexes in rats was studied using complexes derived from DNP-conjugated bovine thyroglobulin (DNP-BTG) and purified specific goat anti-DNP IgG. Both clearance and glomerular localization were mainly dependent on the nature of the antigen. Soluble immune complexes formed with DNP17-BTG were cleared faster and showed a more marked localization in the glomerular mesangium than complexes formed with DNP3.4-BTG. A slight increase in the antibody to antigen ratio seemed to facilitate mesangial localization of soluble immune complexes. Insoluble immune complexes showed temporary localization as microemboli in the lumina of glomerular and peritubular capillaries. This study thus shows that not only the size and composition of the complexes but also the nature of the antigen within the complex can influence the clearance and organ localization of circulating immune complexes.     

Nasal T-cell lymphoma: a clinicopathological and immunophenotypic analysis of 13 cases

Thirteen cases of nasal lymphomas with T-cell or natural killer (NK)-cell phenotype were studied, with attention to clinical presentation and follow-up, the presence of Epstein-Barr virus (EBV) using in situ hybridization (EBER), the immunophenotype, and the presence of cytotoxic granules. All but two patients presented with stage I disease. In three cases local progression resulted in involvement of the central nervous system. When dissemination occurred, this was predominantly to extranodal localizations, in two cases to the skin. Response to therapy was highly variable, but patients treated with radiotherapy with or without additional chemotherapy had a better prognosis than patients treated with initial chemotherapy alone. All lymphomas were associated with EBV, and most cases howed cytotoxic features, ten of which were CD56 positive. In eight cases a T-cell origin was proven, but in five ases a possible NK-cell origin could not be excluded, No clinical differences were seen between true T-cell lymphomas and possible NK-cell neoplasms. Nasal T-cell lymphomas should be considered as a distinct clinicopathological entity, strongly associated with EBV, and with cytotoxic features in most cases. No prognostic parameters were detected to predict dissemination and response to therapy.     

Degradation of Soluble Immunoglobulin Aggregates in Vitro by Monocytes from Normal Subjects and from Patients with Systemic Lupus Erythematosus

The capacity of human peripheral monocytes to degrade soluble immunoglobulin (IgG) aggregates (AIgG) was studied in vitro. Under serum-free conditions peripheral monocytes from normal donors were able to degrade soluble AIgG in a linear and time-dependent fashion. Addition of fresh human or fresh guinea-pig serum to the incubation mixtures caused a marked increase in degradation of the amount of soluble AIgG available. The stimulatory effect of fresh serum was complement-mediated, because it was abolished by heat treatment of the serum and was not seen when C4- or C3-deficient sera were tested. Functional inactivation of C3 receptors on the phagocytes by trypsin also abolished the complement-mediated stimulation, suggesting cooperation between Fc and C3 receptor in degradation of soluble AIgG. No significant differences were found between monocytes from normal donors and those from patients with systemic lupus erythematosus, as far as degradation is concerned in the presence of complement.     

Psychological well-being of informal caregivers of elderly people with dementia: Changes over time

Psychological well-being of caregivers of demented elderly people was investigated during two years of follow-up. Three groups of caregivers were distinguished: those providing care for two years after baseline; those whose care-recipient died within the first year after baseline, and those whose care-recipient was institutionalized within the first year. Compared to general population norms, all groups of caregivers showed a great amount of psychological distress, especially those whose elder suffering from dementia deceased within the first year after baseline. The course of psychological well-being of caregivers who continued to provide care during follow-up supported the wear-and-tear model: an overall deterioration of psychological well-being was found (measured by the GHQ-12, SCL-90-R and SWLS) as elders' functioning declined and caregiving at home continued. Specific increases were found on total amount of psychological distress, but also on the SCL-90-R subscales: Depression, Anxiety, Interpersonal Sensitivity and Paranoid Ideation and Difficulty with Cognitive Performance. No overall changes were found for caregivers whose demented care-recipient had died or was institutionalized in the first year after baseline. These data suggest that the high level of psychological distress and the deterioration in psychological well-being among informal caregivers of dementia patients is a reason to reconsider the merits of the current trend to have demented older people live on their own as long as possible. Additional support should be considered.     

Epidural haematoma after evacuation of contralateral subdural haematoma

Background Sequentially evolving intracranial bilateral haematomas, where the second haematoma develops after the surgical removal of the first one is rarely reported. Aim To report a patient who developed an epidural haematoma after evacuation of a contralateral subdural haematoma. Methods A 49-year-old male was admitted to our department after head injury. A brain computerized tomography (CT) scan revealed an acute subdural haematoma in the right temporal area which was evacuated. During his stay in the intensive care unit, he was submitted to intracranial pressure monitoring, which soon rose. Results A new CT scan showed an acute epidural haematoma in the contralateral parietal area that was also evacuated. Conclusions While rising intracranial pressure after the evacuation of a traumatic haematoma is usually attributed to brain oedema or recurrent haematoma at the craniotomy site, the development of a contralateral epidural haematoma requiring surgical treatment should not be overlooked.