The influence of Helicobacter pylori infection on the occurance of gastroesophageal reflux in patients with renal insufficiency

INTRODUCTION/AIM: Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. METHODS: The examination was organized as a prospective, clinical study and involved 68 patients--33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. RESULTS: The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4 +/- 11.1 vs. 65.4 +/- 12.3 years; p = 0.014). There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03), hiatal hernia (p = 0.008), gastroesophageal reflux disease (p = 0.007), and duodenal ulcer (p = 0.002). Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal tauB = -0.523; p = 0.003) and hiatal hernia (Kendal tauB = 0.403; p = 0.021), while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal tauB = 0.350; p = 0.044). CONCLUSION: Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency.     

Thoracic surgery in solving enormous elevation of the left hemidiaphragm

BACKGROUND: Acquired elevation of the diaphragm is mostly the result of phrenic nerve paralysis, some of thoracic and abdominal patological states, and also some of neuromuscular diseases. Surgical treatment is rarely performed and is indicated when lung compression produces disabilitating dyspnea, and includes plication of diaphragm. The goal of this case report has been to show completely documented diagnostic procedures and surgical treatment one of rare pathological condition. CASE REPORT. A 62-year-old patient was admitted to our clinic because of surgical treatment of the enormous elevation of the left hemidiaphragm. After thoracotomy and plication of the bulging diaphragm, lung compression did not exist any more and mediastinum went back in the normal position. CONCLUSION: Elevation of the diaphragm rarely demands surgical correction. When it is complicated with lung compression and disabilitating dyspnea, surgical treatment has extremely useful functional effect.     

Apoptosis of Hippocampal Pyramidal Neurons Is Virus Independent in a Mouse Model of Acute Neurovirulent Picornavirus Infection

Many viruses, including picornaviruses, have the potential to infect the central nervous system (CNS) and stimulate a neuroinflammatory immune response, especially in infants and young children. Cognitive deficits associated with CNS picornavirus infection result from injury and death of neurons that may occur due to direct viral infection or during the immune responses to virus in the brain. Previous studies have concluded that apoptosis of hippocampal neurons during picornavirus infection is a cell-autonomous event triggered by direct neuronal infection. However, these studies assessed neuron death at time points late in infection and during infections that lead to either death of the host or persistent viral infection. In contrast, many neurovirulent picornavirus infections are acute and transient, with rapid clearance of virus from the host. We provide evidence of hippocampal pathology in mice acutely infected with the Theiler’s murine encephalomyelitis picornavirus. We found that CA1 pyramidal neurons exhibited several hallmarks of apoptotic death, including caspase-3 activation, DNA fragmentation, and chromatin condensation within 72 hours of infection. Critically, we also found that many of the CA1 pyramidal neurons undergoing apoptosis were not infected with virus, indicating that neuronal cell death during acute picornavirus infection of the CNS occurs in a non–cell-autonomous manner. These observations suggest that therapeutic strategies other than antiviral interventions may be useful for neuroprotection during acute CNS picornavirus infection.Many viruses maintain neurovirulent potential, even when the vast majority of infections are silent or subclinical.^1,2,3,4,5 For example, in the correct context, even the common cold virus is neurovirulent.^6,7 Picornaviruses are of particular concern due to ubiquitous distribution, widespread exposure, ease of transmission, and a propensity for neurovirulence.⁸ Non-polio picornaviruses, and especially neurovirulent enteroviruses, are emerging or re-emerging pathogens with the potential for global socio-economic impact.^{1,2,9,10,11,12,13} For example, enterovirus 71(EV71), first isolated from a child with encephalitis in California in 1969, has caused large epidemics with neurological consequences in Eastern Europe and Southeast Asia.¹² Of 130,000 people infected in Taiwan in 1998, 405 required hospitalization for severe central nervous system (CNS) disease.¹⁴ Because EV71 infection results in clinical manifestations predominantly in infants and young children,¹² the potential for long-term cognitive consequences is significant. Indeed, subsequent follow-up of those hospitalized patients that survived acute infection in the 1998 Taiwan outbreak revealed that many suffered long-term neurological deficits,¹⁵ including attention-deficit/hyperactivity disorder.¹⁶ These cognitive deficits were most pronounced in young children.¹⁵The indispensable and largely irreplaceable nature of neurons in the CNS requires that these cells maintain a flawless apoptotic balance. Viral infection of the CNS is known to alter this tightly regulated equilibrium, leading to neuron death.⁸ For example, acute CNS infection by members of the neurotropic picornavirus family, including Theiler’s murine encephalomyelitis virus (TMEV),^17,18 the coxsackieviruses,¹⁹ and encephalomyocarditis virus,^20,21 induces the death of hippocampal neurons in a range of hosts.⁸ Case reports indicate that infection with neurovirulent picornaviruses results in extensive hippocampal lesions and cognitive impairment in humans.^15,22,23 Likewise, in mice acutely infected with TMEV, we have observed damage to the CA1 hippocampal subfield and a consequent inability to form spatial memories.¹⁷ A previous study concluded that hippocampal neuronal apoptosis during TMEV infection was a cell-autonomous event triggered by direct neuron infection, and that cell death was a protective response that limited viral replication before the development of a humoral or cellular immune response.²⁴ However, this previous study only assessed neuron death at one time point (7 days postinfection [dpi]) and within a viral infection system that either killed the host by overwhelming viral encephalitis or led to persistent viral infection of the CNS. In contrast to fatal or chronic viral models, many common neurovirulent picornavirus infections are acute and transient, with clearance of virus from the host CNS and rapid disease resolution.²⁵ Based on this discrepancy, we used the Daniel’s strain of TMEV and an infection paradigm in mice of the H-2^b major histocompatibility complex haplotype that models an acute brain infection that is cleared from the host CNS within 14 to 21 dpi.²⁶ We exploited this model to evaluate CNS pathology in mice infected with a neurovirulent picornavirus and to elucidate the canonical mechanisms underlying neuronal apoptosis in the hippocampus of infected hosts.     

Modified Bentall procedure - 'a collar technique' to control bleeding from coronary ostia anastomoses

Composite conduit aortic root replacement has become widely accepted as the preferred treatment for ascending aorta aneurysm and dissection. We present a patient in whom creation of 'buttons' was impossible due to fragility of the ascending aorta wall. The distal anastomosis was made to the transected aorta. The remnant of the proximal ascending aortic wall was fully transected 8-9 mm above the upper edge of coronary ostia anastomoses (incorporated into conduit using inclusion technique), thus forming a 'collar' around the proximal part of the conduit. At the end of the procedure the 'collar' was anchored to the conduit to control persistent bleeding from coronary ostia anastomoses.     

Sialendoscopy and CT Navigation Assistance in The Surgery of Sialolithiasis

BackgroundA sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations.Patients and methodsAl l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation.ResultsWe performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands.ConclusionsThe addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.Key words: sialendoscopy, sialolithiasis, surgical navigation, computer tomography     

The Importance of Flaps in Reconstruction of Locoregionally Advanced Lateral Skull-base Cancer Defects: a Tertiary Otorhinolaryngology Referral Centre Experience

BackgroundThe aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer.Patients and methodsThe retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made.ResultsTwelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive.ConclusionsFavourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.Key words: temporal bone, microsurgery, parotid region, free tissue flaps, neoplasm staging, ear     

Survival of patients with transitional cell carcinoma of the ureter and renal pelvis in Balkan endemic nephropathy and non-endemic areas of Serbia

OBJECTIVE: To evaluate the characteristics and survival of patients with upper urinary tract (UUT) transitional cell carcinoma (TCC) in Serbia, followed for >/=5 years or until death. PATIENTS AND METHODS: From 1998 to 2005 we analysed 114 cases of pathologically confirmed UUT TCC, divided into two groups according to topographical characteristics, and compared their demographic, clinical and pathological characteristics. The influence of various factors on overall 5-year survival of patients with UUT TCC was also tested. The prognostic value of different variables was assessed by univariate and multivariate Cox proportional-hazard models. RESULTS: The most important change in demographic characteristics of the patients with UUT TCC in Serbia was a similar proportion of patients residing in areas of Balkan endemic nephropathy (BEN) and non-endemic areas. The median (range) follow-up was 67 (46-88) months. The 5-year probability of survival was 51.2 +/- 5.8%. There was a significantly lower probability of 5-year survival for patients with a higher histological grade (P = 0.001), higher T stage (P < 0.001) and tumour size >3 cm (P = 0.001) at diagnosis. In this cohort of patients the independent predictors of a poorer outcome of the disease were being female (hazard ratio, HR, 2.2, P = 0.010), tumour size >3 cm (HR 2.8, P = 0.001) and T3 or T4 stages (HR 3.1, P = 0.001). CONCLUSION: Comparative analysis of the characteristics of UUT TCC between patients from BEN and non-endemic areas of Serbia showed similarities in demographic, clinical and pathological features. Factors that significantly influenced survival of patients with UUT TCC were being female, tumour size and tumour grade and stage.