Microvasculature of the esophagus and gastroesophageal junction: Lesson learned from submucosal endoscopy

Advanced therapeutic endoscopy,in particular endoscopic mucosal resection,endoscopic submucosal dissection,per-oral endoscopic myotomy,submucosal endoscopic tumor resection opened a new era where direct esophageal visualization is possible.Combining these information with advanced diagnostic endoscopy,the esophagus is organized,from the luminal side to outside,into five layers(epithelium,lamina propria with lamina muscularis mucosa,submucosa,muscle layer,adventitia).A specific vascular system belonging to each layer is thus visible: Mucosa with the intra papillary capillary loop in the epithelium and the sub-epithelial capillary network in the lamina propria and,at the lower esophageal sphincter(LES) level with the palisade vessels; submucosa with the drainage vessels and the spindle veins at LES level; muscle layer with the perforating vessels; periesophageal veins in adventitia.These structures are particularly important to define endoscopic landmark for the gastro-esophageal junction,helpful in performing submucosal therapeutic endoscopy.     

Incidence of epilepsy in a racially diverse, community-dwelling, elderly cohort: results from the Einstein aging study

OBJECTIVE: To determine age-specific incidence and cumulative incidence of epilepsy in a well-defined cohort of elderly people, and to examine how rates of epilepsy are modified by sex, race, stroke, dementia, head injury, and depression. METHODS: The authors examined data from a reconstructed cohort based on 1919 community-dwelling volunteers, followed as part of a large ongoing prospective aging study. RESULTS: Age-specific incidence was 10.6 (per 100,000 person-years) between ages 45 and 59, 25.8 between ages 60 and 74, and 101.1 between ages 75 and 89. Cumulative incidence was 0.15% from age 45 to age 60, 0.38% to age 70, 1.01% to age 80, and 1.47% to age 90. In addition, the difference in cumulative incidence among African-American subjects approached statistical significance (57.6/100,000 person-years versus 26.1 in Caucasian, p=0.10), and the difference in incidence among subjects reporting a history of stroke was significantly elevated (p=0.029). Incidence of epilepsy was not statistically elevated among males, those with dementia, or individuals reporting a history of head injury or treatment for depression. Among "healthy" subjects without history of stroke, head injury, or dementia, we observed a cumulative risk of epilepsy with onset after age 60 of only 1.1%. CONCLUSIONS: The incidence of epilepsy was low in this relatively healthy cohort of elderly people, especially among subjects without known risk factors. In this study we identified African-American race as a risk factor in the elderly for epilepsy independent of stroke.     

Hallervorden-Spatz disease

We describe fluid attenuated inversion recovery sequence MRI and proton MR spectroscopy appearances of the brain in a 7-year old Saudi boy who presented with the clinical features of Hallervorden-Spatz disease to King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.     

To Estimate the Effect of Relationship of Salt Iodine Level and Prevalence of Goiter Among Women of Reproductive Age Group (15–49 Years)

The present study is a Cross-Sectional Study and was conducted in Post-graduate department of Community Medicine, Govt. Medical College, Srinagar between Feb. 2012 and Jan. 2013. The sample size of 1,041 was estimated. The study was conducted to estimate the effect of relationship of salt iodine level and prevalence of goiter among women of reproductive age group in two districts of Kashmir valley, district Srinagar and district Ganderbal, which were selected randomly. A frame of the blocks and villages in the two districts and their population was formed. From each district 10 % of the blocks were selected using simple random sampling. From each block, 5 % of the villages were selected using simple random sampling. A door to door survey was conducted in the selected villages and all the women in the reproductive age group (15–49 years) identified and examined clinically for goiter after taking informed consent. Salt samples (one teaspoonful) from every household were taken and assessed for iodine content on spot and the iodine content of salt was assessed qualitatively by spot testing kits. The results of the present study have indicated that iodine deficiency continues to be a health problem. Almost the whole population consumes powdered salt but the storage and cooking practices diminish the iodine content of salt and results in decreased intake. Thus the need of the hour is to make people aware about proper storage and cooking practices. Women in the reproductive age group especially need to be made aware about the importance of consumption of adequately iodized salt because of the wide range of ill effects of iodine deficiency on the developing fetus and the growing child. In addition monitoring of iodine content of salt at distributor level should be done.