Oesophageal mucosal intercellular space diameter and reflux pattern in childhood erosive and non-erosive reflux disease

Background and aims

We sought to compare intercellular space diameter in children with non-erosive and erosive reflux disease, and a control group. We also aimed to characterize the reflux pattern in erosive and non-erosive reflux disease patients, and to explore the relationship between intercellular space diameter values and reflux parameters.

Methods

Twenty-four children with non-erosive reflux disease, 20 with erosive reflux disease, and 10 controls were prospectively studied. All patients and controls underwent upper endoscopy. Biopsies were taken at 2–3 cm above the Z-line, and intercellular space diameter was measured using transmission electron microscopy. Non-erosive and erosive reflux disease patients underwent impedance-pH monitoring.

Results

Mean intercellular space diameter values were significantly higher in both non-erosive (0.9 ± 0.2 μm) and erosive reflux disease (1 ± 0.2 μm) compared to controls (0.5 ± 0.2 μm, p < 0.01). No difference was found between the two patient groups. Acid exposure time, the number of acid, weakly acidic and weakly alkaline reflux events did not differ between the two patient groups. No difference was found in the mean intercellular space diameter between non-erosive reflux disease children with and without abnormal acid exposure time (1 ± 0.3 vs. 0.9 ± 0.2 μm). No correlation was found between any reflux parameter and intercellular space diameter values.

Conclusions

Dilated intercellular space diameter seems to be a useful and objective marker of oesophageal damage in paediatric gastro-oesophageal reflux disease, regardless of acid exposure. In childhood, different gastro-oesophageal reflux disease phenotypes cannot be discriminated on the basis of reflux pattern.     

Blood Pressure Changes in Adolescents with Preeclampsia: A Multicentre,Case-Control Study in Latin American Hospitals

ObjectiveTo determine the minimum blood pressure increases that would confirm or exclude, with the greatest predictive values, hypertensive disorders of pregnancy (HDP) in pregnant adolescents after 24 weeks gestation.MethodsWe conducted a case-control study of pregnant women aged ≤19 years with and without HDP. Using systolic and diastolic blood pressure increases, a predictive analysis was performed, and the area under the curve was calculated.ResultsThe cases and controls had systolic blood pressure increases of 45.3 ± 17.5 mm Hg and 6.4 ± 7.9 mm Hg, respectively (P = 0.001) and diastolic blood pressure increases of 30.8 ± 11.7 mm Hg and 3.5 ± 5.7 mm Hg, respectively (P = 0.001). Systolic and diastolic increases of ≥20 mm Hg showed the greatest sensitivity and specificity. A combined analysis showed that an increase of ≥20 mm Hg had a greater positive likelihood ratio of 35.4 (95% CI 22.4–55.9) and negative likelihood ratio of 0.10 (95% CI 0.07–0.13), with an area under the curve of 0.98 (95% CI 0.96–0.99).ConclusionsSystolic and diastolic blood pressure increases of ≥20 mm Hg must be considered in the diagnostic criteria for preeclampsia and gestational hypertension among pregnant adolescents past 24 weeks gestation.     

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Background

Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB.

Methods

A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand^® (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered.

Results

From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21–62 years); mean BMI = 46.7 ± 7.7 kg/m² (range 37.3–68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36–130); %EW 91.1 ± 32.4 % (range 21–112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of follow-up, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6–12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not.

Conclusions

Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.     

Primary hepatic lymphoma: A case report

INTRODUCTIONPrimary hepatic lymphoma is a rare malignancy which misdiagnosis and mistreatment is very frequent. Differential diagnosis of the hepatic lesion, based on the noninvolvement of blood vessels, includes: fatty infiltration, cirrhosis, amyloid infiltration, primary hepatomas, and metastatic neoplasms.PRESENTATION OF CASEWe describe a case of a 69-year-old man who presented with 15% weight loss and general fatigue over the previous 9 months. Physical examination revealed hepatomegaly without lymphadenopathy or splenomegaly. Magnetic resonance imaging showed a 13 cm × 9 cm × 11 cm tumor on the right liver associated with normal levels of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA). After two negatives ultrasonography-guided needle liver biopsies, the third one showed diffuse infiltration of large sized lymphoid cells. Immunohistochemical findings demonstrated the B-lymphocyte lineage of the tumor. The patient received R-CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) with good response.DISCUSSIONIt is important to recognize PHL because it responds favorably to chemotherapy and may have a better prognosis than hepatocellular carcinoma or metastatic disease of the liver. When imaging findings on CT scans and MRI are nonspecific, a biopsy is needed not only for a definitive diagnosis but also for identifying the immunophenotype of the PHL. This type of lesion is highly chemosensitive and early aggressive chemotherapy may result in sustained remission.CONCLUSIONThis case emphasizes the importance of effective recognition of PHL considering its good response to chemotherapy and the possibility of sustained remission if early aggressive treatment is implemented.     

Effect of a recombinant manganese superoxide dismutase on prevention of contrast-induced acute kidney injury

Background

Contrast media (CM)-induced nephropathy (CIN) is an acute deterioration of renal function following administration of CM mediated to a large extent by the increased production of ROS within the kidney. Aim of this study was to evaluate whether a novel isoform of a recombinant Manganese SOD (rMnSOD) could provide an effective protection against CIN; this molecule shares the same ability of physiological SODs in scavenging reactive oxygen species (ROS) but, due to its peculiar properties, enters inside the cells after its administration.

Methods

We studied the effects rMnSOD on oxidative damage in a rat model of CIN in uninephrectomized rats, that were randomly assigned to 3 experimental Groups: Group CON, control rats treated with the vehicle of CM, Group HCM, rats treated with CM and Group SOD, rats treated with CM and rMnSOD.

Results

In normal rats, pretreatment with rMnSOD, reduced renal superoxide anion production, induced by the activation of NAPDH oxidase, by 84 % (p < 0.001). In rats of Group HCM, ROS production was almost doubled compared to rat of Group CON (p < 0.01) but returned to normal values in rats of Group SOD, where a significant increase of SOD activity was detected (+16 % vs HCM, p < 0.05). Administration of CM determined a striking fall of GFR in rats of Group HCM (?70 %, p < 0.001 vs CON), greatly blunted in Group SOD (?28 % vs CON, p < 0.01); this was associated with a lower presence of both tubular necrosis and intratubular casts in SOD-treated rats (both p < 0.01 vs Group HCM).

Conclusions

Our data indicate that rMnSOD is able to reduce renal oxidative stress, thus preventing the reduction of GFR and the renal histologic damage that follows CM administration.     

Hospital costs associated with depression in a cohort of older men living in Western Australia

Background

There is lack of information of the hospital costs related to depression. Here, we compare the costs associated with general hospital admissions over 2 years between older men with and without a documented past history of depression.

Methods

A community-based cohort of older men living in Perth, Western Australia, was assessed at baseline between 2001 and 2004 and followed up for 2 years by prospective data linkage. The participants were selected randomly from the Australia electoral roll. Two-year hospital costs were estimated.

Results

Among 5411 patients, 75% of 339 men with depressive symptoms had at least one hospital admission compared with 61% of 5072 men without depression (P< .001). Two-year median hospital costs in the depressed group were A$4153 compared with A$1671 in participants free from depression (P< .001). In multivariate analysis, the presence of clinically significant depressive symptoms remained an independent predictor of higher cost [incident rate ratios (RR)=1.44, 95% confidence interval (CI): 1.23–1.68] and was associated with being a high-cost user of health services (RR=2.04, 95% CI: 1.43–2.92).

Limitations

The estimation of costs was solely based on the main diagnosis, potentially leading to underestimates of the real cost differences.

Conclusions

Hospital care cost was higher for older men with documented evidence of past depression than those without. The issue of depression in later life must be tackled if we want to optimize the use of limited hospital resources available.     

Searching for double σ- and π-aromaticity in borazine derivatives

Inspired by the double-aromatic (σ and π) C₆H₃⁺, C₆I₆²⁺, and C₆(SePh)₆²⁺ ring-shaped compounds, herein we theoretically study their borazine derivative analogues. The systems studied are the cation and dications with formulas B₃N₃H₃⁺, B₃N₃Br₆²⁺, B₃N₃I₆²⁺, B₃N₃(SeH)₆²⁺, and B₃N₃(TeH)₆²⁺. Our DFT calculations indicate that the ring-shaped planar structures of B₃N₃H₃⁺, B₃N₃I₆²⁺, and B₃N₃(TeH)₆²⁺ are more stable in the singlet state, while those of B₃N₃Br₆²⁺ and B₃N₃(SeH)₆²⁺ prefer the triplet state. Besides, exploration of the potential energy surface shows that the ring-shaped structure is the putative global minimum only for B₃N₃I₆²⁺. According to chemical bonding analysis, B₃N₃H₃⁺, B₃N₃I₆²⁺, and B₃N₃(TeH)₆²⁺ have σ and π delocalized bonds. The number of delocalized σ/π electrons is 2/6 for the first, and 10/6 for the second and third, similar to what their carbon analogs exhibit. Finally, the analysis of the magnetically induced current density allows B₃N₃H₃⁺, B₃N₃I₆²⁺, and B₃N₃(TeH)₆²⁺ to be classified as strongly σ aromatic, and poorly π aromatic compounds.

Evolutionary algorithms, Born–Oppenheimer molecular dynamics and the magnetic criteria of aromaticity have been used to evaluate the stability and σ–π aromaticity of borazine derivatives in order to expand the family of double aromatics systems.