Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry

Gastric Cancer - Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical...     

Colonic Hydrogen Elimination and Methane Production in Infants with and Without Infantile Colic Syndrome

Our objective was to investigate the relationship between demographic factors, nutrition, stool gas production, and the existence of infantile colic (IC) syndrome. Hydrogen and methane production from stool specimens of infants with and without infantile colic was quantified at two separate time points, the age at presentation of colic (<12 weeks) and at 6 months of age. The relationship between demographic variables and IC was also studied. A total of 59 infants with ages ranging from 2 to 12 weeks were enrolled in the study. Of these, 30 infants developed symptoms of colic. No correlation was found between IC and birth weight, gestational age, sex, type of feeding, mean time of feeding, stool frequency, and consistency. There was also no correlation between IC and the parents' age or education or the infant's number of siblings. Analysis of the stool samples revealed that methane was produced at concentrations >2 ppm by 15.3% of the infants at age <3 months and by 46.4% of infants at age >6 months. The mean methane concentrations produced by stool increased with age (0.95 ± 0.58 ppm at 3 months of age vs 1.29 ± 0.65 ppm at 6 months of age. There was no difference in stool hydrogen concentration between infants with and without IC. In contrast, the mean methane level at 3 and 6 months of age was higher in infants without IC than with IC, but reached statistical significance only at 6 months of age (0.97 ± 0.68 vs 0.93 ± 0.46) (NS) at 3 months of age, and 1.56 ± 0.55 vs 0.93 ± 0.62 (P<0.05) at 6 months of age respectively. Furthermore, infants that produced higher methane levels at 3 and 6 months of age had significantly (p<0.05) less colic in the first months of life. In conclusion, methane production may play a role in the alleviation of IC. Future studies are needed to confirm our findings.     

Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines

Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment, and their condition has not improved. Biliary drainage can be achieved via three different routes/procedures: endoscopic, percutaneous transhepatic, and open methods. The clinical value of both endoscopic and percutaneous transhepatic drainage is well known. Endoscopic drainage is associated with a low morbidity rate and shorter duration of hospitalization; therefore, this approach is advocated whenever it is applicable. In endoscopic drainage, either endoscopic nasobiliary drainage (ENBD) or tube stent placement can be used. There is no significant difference in the success rate, effectiveness, and morbidity between the two procedures. The decision to perform endoscopic sphincterotomy (EST) is made based on the patient’s condition and the number and diameter of common bile duct stones. Open drainage, on the other hand, should be applied only in patients for whom endoscopic or percutaneous transhepatic drainage is contraindicated or has not been successfully performed. Cholecystectomy is recommended in patients with gallbladder stones, following the resolution of acute cholangitis with medical treatment, unless the patient has poor operative risk factors or declines surgery.     

Technique for soft tissue closure in surgeries for fixed implant-supported prostheses in the edentulous maxilla

A technique is presented that can be used as a straightforward, quick, and minimally invasive solution to improve soft tissue closure for surgeries involving bone reduction for fixed implant-supported prostheses in the edentulous maxilla.     

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population – Part 3: Unblinded and Discriminatory Subjective Analysis

Purpose

To study the subjective differences in direct lip support assessments and to determine if dentists and laypeople are able to discern and correctly identify direct changes in lip support between flange and flangeless dentures.

Materials and Methods

A random sample of 20 maxillary edentulous patients described in part 2 of the study was used for analysis. A total of 60 judges comprising 15 general dentists, 15 prosthodontists, and 30 laypeople, the majority of who were distinct from part 2 of the study, were recruited. All images used in this study were cropped at the infraorbital level and converted to black and white tone, to encourage the judges to focus on lip support. The judges were un‐blinded to the study objectives and told what to look for, and were asked to rate the lip support of each of the 80 images on a 100 mm visual analog scale (VAS). The judges then took a discriminatory sensory analysis test (triangle test) where they were required to correctly identify the image with a flangeless denture out of a set of 3 images. Both the VAS and triangle test ratings were conducted twice in a random order, and mean ratings were used for all analyses.

Results

The overall VAS ratings of lip support for images with flangeless dentures were slightly lower compared to images with labial flanges, and this difference was statistically significant (p < 0.0001). This was true for both profile and frontal images. However, the magnitude of these differences was too small (no greater than 5 mm on a 100‐mm scale) to be clinically significant or meaningful. The differences in VAS ratings were not significant between the judges. For the triangle test, judges overall correctly identified the flangeless denture image in 55% of frontal image sets and 60% of profile image sets. The difference in correct identification rate between frontal and profile images was statistically significant (p < 0.0001). For frontal and profile images, prosthodontists had the highest correct identification rate (61% and 69%), followed by general dentists (53% and 68%) and by laypeople (53% and 50%). The difference in correct identification rate was statistically significant between various judges (p = 0.012). For all judges, the likelihood of correctly identifying images with flangeless dentures was significantly greater than 1/3, which was the minimum chance for correct identification (p < 0.0001).

Conclusions

Removal of a labial flange in a maxillary denture resulted in slightly lower ratings of lip support compared to images with a labial flange, but the differences were clinically insignificant. When judges were forced to look for differences, flangeless dentures were detected more often in profile images. Prosthodontists detected the flangeless dentures more often than general dentists and laypeople.