The sentinel node biopsy in early gastric cancer: a preliminary study

Background and aims Sentinel node biopsy is currently used in surgery of malignant melanoma and breast cancer. The feasibility of sentinel node mapping in gastrointestinal cancers and its diagnostic sensitivity is unclear. It could be of particular value in the management of early gastric cancer in which radical D2 lymphadenectomy may be unnecessary. Materials and methods From January 2004 to June 2005, ten patients with preoperative diagnosis of early gastric cancer and no nodal involvement (cT1N0) were submitted to sentinel node biopsy using the dual mapping procedure with endoscopic blue dye and ^99mTc radio colloid injection. All the patients underwent standard radical gastrectomy and D2 lymphadenectomy. The resected nodes were evaluated by routine (hematoxylin–eosin) histopathological examination; the sentinel (blue or hot) nodes, in addition, were evaluated with immunohistochemistry for cytokeratin. Results The detection rate of this procedure was 100%. The preliminary results and perspectives for feasibility of sentinel node biopsy and its accuracy in predicting the nodal status in early gastric cancer are discussed.     

Detection of ∆<Superscript>9</Superscript>-tetrahydrocannabinol in exhaled breath after cannabis smoking and comparison with oral fluid

Exhaled breath is commonly used in alcohol testing, but has been recently demonstrated by scientists from Sweden, Germany, Belgium, Switzerland, and the United States to contain a large number of both volatile and non-volatile substances that can be measured using dedicated devices. ExaBreath^® is a sampling device that collects the bio-aerosol particles from the donor. Approximately 2 min exhaled breath is enough for the test. The device collects the very small bio-aerosols on a filter, which is consecutively incubated into methanol to release drugs at a laboratory. Four occasional cannabis smokers were recruited for this study. Oral fluid, collected with the Quantisal^® device, and exhaled breath were simultaneously collected up to 6 h after smoking a standard joint of cannabis. ?⁹-Tetrahydrocannabinol (THC) was tested using liquid chromatography–tandem mass spectrometry (MS/MS) or gas chromatography–MS/MS for exhaled breath and oral fluid, respectively. Linearity, precision and limit of quantification (5 pg/filter and 0.5 ng/mL for exhaled breath and oral fluid, respectively) were established. In each analytical batch, low and high controls were included. THC was identified in exhaled breath up to 6 h after smoking from all the four subjects, with concentrations in the range 15–1598 pg/filter. THC breath concentrations significantly decreased with time after smoking in all four participants. All the oral fluid specimens tested positive for THC over the 6 h of the study, with concentrations in the range 1–89 ng/mL. 11-Nor-9-carboxy-Δ⁹-tetrahydrocannabinol, the main metabolite of THC was also analysed, but was undetectable in both exhaled breath and oral fluid. This study gives further support to the possibility of using exhaled breath as a new matrix to document exposure to drugs, particularly for cannabis.     

Functional studies on c.1347C>T,a polymorphism modulating phenotypic outcome in X-linked adrenoleukodystrophy

Tijdschrift voor Kindergeneeskunde -     

Characteristics of the sequence effect in Parkinson's disease

The sequence effect (SE) in Parkinson's disease (PD) is progressive slowing of sequential movements. It is a feature of bradykinesia, but is separate from a general slowness without deterioration over time. It is commonly seen in PD, but its physiology is unclear. We measured general slowness and the SE separately with a computer‐based, modified Purdue pegboard in 11 patients with advanced PD. We conducted a placebo‐controlled, four‐way crossover study to learn whether levodopa and repetitive transcranial magnetic stimulation (rTMS) could improve general slowness or the SE. We also examined the correlation between the SE and clinical fatigue. Levodopa alone and rTMS alone improved general slowness, but rTMS showed no additive effect on levodopa. Levodopa alone, rTMS alone, and their combination did not alleviate the SE. There was no correlation between the SE and fatigue. This study suggests that dopaminergic dysfunction and abnormal motor cortex excitability are not the relevant mechanisms for the SE. Additionally, the SE is not a component of clinical fatigue. Further work is needed to establish the physiology and clinical relevance of the SE. © 2010 Movement Disorder Society.     

The role of the duodenal microflora as a determinant of persistent diarrhoea

It has been suggested that proliferation of enterobacteriaceae and/or anaerobes in the duodenum of some children with acute diarrhoea determines whether the episode becomes persistent. A review of published studies and the comparison of cultures of duodenal aspirates from Peruvian children with acute and persistent diarrhoea and diarrhoea-free children did not support this hypothesis. Although many children had enterobacteriaceae and/or anaerobes cultured there was no correlation with clinical and nutritional outcome. Age, nutritional status, the environment and the aetiology of the episode were determinants of the duodenal microflora independent of diarrhoea. Culture of the duodenal aspirates did not increase the yield of enteropathogens which were isolated more frequently from stools than from the duodenum. Despite the presence of a single strain or serotype of enterobacteriaceae suggesting that these bacteria were colonizing the duodenum, we were unable to demonstrate any adherence mechanisms in the majority of them. Two often bacteria with no other evidence of virulence caused diarrhoea in the RITARD rabbit model.