Ethanol‐induced relaxation of mouse esophagus: subcellular mechanisms

Ethanol (164 mm ) produced reproducible relaxations in isolated mouse esophageal strips. Hexamethonium (10–500 μm ), a ganglionic blocking agent, and lidocaine (10–100 μm ), a local anesthetic agent, failed to affect the relaxations induced by ethanol in the mouse esophagus. Although verapamil (10–500 μm ), a selective blocker of L‐type Ca²⁺ channels, failed to affect the relaxations to ethanol, ruthenium red (10–100 μm ), a selective blocker of ryanodine receptors (intracellular Ca²⁺ channels), and cyclopiazonic acid (1–10 μm ), a selective blocker of sarcoplasmic reticulum Ca²⁺ ATPase (SERCA), significantly inhibited these relaxations. In addition, tetraethylammonium (10–100 μm ), a potassium‐selective ion channel blocker and N^ω‐nitro‐l ‐arginine (l ‐NOARG; 10–500 μm ), a specific inhibitor of nitric oxide synthase (NOS), neomycin (10–500 μm ), a phospholipase C inhibitor and indomethacine (1–10 μm ), a non‐selective COX inhibitor, significantly inhibited the relaxations induced by ethanol. In contrast ouabain (10–100 μm ), an inhibitor of Na⁺–K⁺‐ATPase, failed to cause significant alteration on these relaxations in the same tissue. The results of the present study suggest that the inhibitory effect of ethanol on the mouse esophagus may be direct effect of ethanol on the muscle tissue rather than neuronal effect. In addition, intracellular but not extracellular Ca²⁺ may have a role on ethanol‐induced relaxations in isolated mouse esophageal strips. Potassium channels and nitric oxide may also have a role on these relaxations. Similarly, phospholypase C and arachidonic acid pathways may contribute the relaxations to ethanol. However Na⁺–K⁺‐ATPase may not have a role on relaxations induced by ethanol in the mouse esophagus.     

D‐dimer as a predictor of the need for laparotomy in patients with unclear non‐traumatic acute abdomen. A preliminary study

Objective. The acute onset of intense abdominal pain requires rapid evaluation, and since D‐dimer level is reported to be useful in the diagnosis of patients with suspected acute superior mesenteric artery occlusion, our aim was to evaluate the value of D‐dimer testing in the diagnosis of acute surgical abdomen with no precise diagnosis. Material and methods. Between July 2004 and June 2006, 93 patients with acute abdomen who required surgical exploration without precise diagnosis were admitted to this prospective clinical study. After surgery, the patients were divided into two groups: group 1 (n = 52), patients who needed immediate laparotomy, and group 2 (n = 41), patients without the need for laparotomy. Blood samples were taken to analyse D‐dimer, white blood cell count and pH level. P‐values of <0.05 were considered statistically significant. Results. There was a positive correlation between the plasma D‐dimer level and leucocyte count. Leucocyte counts >16,800/mm³ (p<0.01) and D‐dimer levels >4.7?µg?FEU/mL were more sensitive (p<0.001). Sensitivity was 97.6?% and specificity 61.5?% for D‐dimer level, and 82.9?% and 42.3?%, respectively, for leucocyte count. Metabolic acidosis at admission was the most important factor for mortality (p<0.001). Conclusions. In a patient with acute abdomen without precise diagnosis, a D‐dimer level above the cut‐off value (4.7?µg fibrinogen equivalent units/mL) may be an indicator with high sensitivity for surgical pathology requiring laparotomy.     

Impact of <Emphasis Type="Italic">H. Pylori</Emphasis> on Growth: Is the Infection or Mucosal Disease Related to Growth Impairment?

Background  

Helicobacter pylori (H. pylori) has been recognized as one of the most common chronic bacterial infections in the world. Most children are colonized in early childhood, and the infection will last a lifetime unless the child is treated with appropriate antibiotics.     

Use and effectiveness of prothrombin complex concentrates vs fresh frozen plasma in gastrointestinal hemorrhage due to warfarin usage in the ED

Objectives

High International Normalized Ratio (INR) level resulting from warfarin use increases the risk of gastrointestinal hemorrhages. We aimed to compare the efficacy of prothrombin complex concentrates (PCC) and fresh frozen plasma (FFP) at lowering the INR level, decreasing active hemorrhages visible by endoscopy, and shortening the length of stay at the emergency department (ED).

Method

This study is a prospective cohort study of consecutive patents with gastrointestinal hemorrhages that received either PCC or FFP. With strict exclusion criteria, only patients over 18 years of age with a high INR level (> 2.1) due to warfarin usage were included.

Results

A total of 40 patients (18 female) were included in the study, 20 each in the PCC and FFP groups. For the PCC group, the mean INR levels at the second and sixth hours were lower than those for the FFP group (second hour INR: 1.53 vs 4.50, P < .01, sixth hour INR: 1.52 vs 2.41, P < .01). Seven patients experienced active bleeding (Forrest 1) in the FFP group, whereas no patient experienced active bleeding in the PCC group based on the Forrest classification (35% vs 0%, P < .01), and only 3 patients in the FFP group underwent invasive/surgical treatment (15% vs 0%, P < .01). The ED length of stay was lower for the PCC group (1.62 days vs 3.46 days, P < .01).

Conclusion

For patients experiencing a gastrointestinal hemorrhage, INR levels were reversed more quickly, there was less active bleeding on endoscopy, and the ED length of stay was lower in the PCC group than in the FFP group.     

Reduction of anterior shoulder dislocations by Spaso technique: clinical results

The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. All reductions were performed by residents in training. Rescue methods if initial reduction was unsuccessful were at the discretion of the treating physician. Fifty-two patients were enrolled and 39 (75%) dislocations were successfully reduced without anesthesia or assistance. The mean reduction time was 3.2 min, and 87% of successful reductions occurred in less than 5 min. If we exclude the first 20 cases as a learning period, the success rate increases up to 87.5%. There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.     

Epidemiology and clinical characteristics of migraine among school children in the Menderes region

The goal of this study was to collect and analyse information on the prevalence of childhood migraine and disability due to migraine in primary school children of 4th to 8th grades (ages ranging from 9 to 17 years) in the Aydin urban area. A cross-sectional school-based study was conducted between March and June 2004. There were 76 333 children of 4th to 8th grades in primary schools in Aydin. Nearly 10% of this population (7721 out of 76 333) was evaluated by a multistage clustered sampling procedure. Four questionnaire forms were applied to each child by a study neurologist during class time. Questionnaire A consisted of a single question, 'Have you ever had a headache?'. To those who responded 'yes', questionnaire B was applied as a second step, which consisted of eight questions. Diagnosis of migraine headache was made according to International Classification of Headache Disorders 2004. Migraine disability was measured with questionnaire C, which was originally the Pediatric Migraine Disability Assessment (PedMIDAS). Migraine history, previous migraine diagnosis and pain intensity were measured with questionnaire D. According to questionnaire A, 79.6% of boys and 87.1% of girls suffered from headaches. The prevalence of migraine was 9.7% (7.8% in boys, 11.7% in girls) according to questionnaire B. The male:female ratio was 1:1.5. Total PedMIDAS score was 9.94 +/- 8.41 days in boys and 11.50 +/- 12.28 days in girls. Only 1.9% of the children had previously been diagnosed with migraine. The average migraine headache history was 2.48 +/- 1.18 years in girls and 2.57 +/- 1.18 years in boys. Although migraine is a common health problem among school children in Aydin, it is mostly still under-recognized.     

Emergency admissions due to swallowed foreign bodies in adults

AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED between January 1stand December 31stof 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.RESULTS:A total of 100 patients presented with a complaint of foreign body ingestion during the study period.Overall,an X-ray was performed on 75 patients,and a fiberoptic evaluation was performed on45 patients.A foreign body was detected in 46(46%)patients.The diagnostic yield of the X-ray was 27(36%)out of 75 patients,while the diagnostic yield of the fiberoptic evaluations was 21(47%)out of 45 patients.The detected foreign bodies were mostly located in the esophagus(17 out of 46 foreign bodies detected).When the types of ingested foreign bodies were evaluated,52(52%)patients reported ingesting food,and19(19%)patients reported swallowing pins.An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases.In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation,the foreign material was detected and removed.CONCLUSION:Plain radiography is helpful in the localization of radiopaque swollen foreign bodies,while fiberoptic methods are useful as both diagnostic and therapeutic tools,regardless of radiopacity.     

Current investigational drugs in psoriasis

INTRODUCTION: The advent of biologic therapies has revolutionized the treatment of psoriasis. Increased understanding of immunogenetic pathways has allowed for the development of more selective targeted biologic therapies. Multiple new treatments are currently in development for the treatment of psoriasis. Preliminary data for many of these agents, particularly with regard to agents targeting the IL-23/Th17 pathway, are promising. Proven long-term safety, however, is an absolute necessity with newly developed drugs, and should, therefore, still be considered second-line agents to current established treatments with long-term safety data. AREAS COVERED: This review details the mechanisms of action of drugs currently in development or in clinical trials for the treatment of psoriasis, using clinical trial registries and associated publications. Readers will gain a comprehensive overview about the mechanism of action of emerging treatments targeting various immune pathways deeply involved in psoriasis. Pathogenesis, clinical efficacy and safety data for these treatments are discussed where available. EXPERT OPINION: Psoriasis remains a heavily undertreated systemic immune-mediated disease despite increased understanding of immunopathogenesis of the disease and advent of a multitude of novel therapeutic agents with potentially improved bioavailability and safety profiles. Limitations, however, remain in the realm of topical agents for treatment of mild to moderate psoriasis, which has seen little progress over the years. A concerted effort will need to be made among researchers, clinicians and patient advocacy groups to ensure new therapeutic agents are developed and gain proper exposure.     

Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation

The purpose of this study was to evaluate the early clinical outcomes of the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction using biodegradable cross pin fixation. The nature of this study is a prospective nonrandomized clinical outcome study. Thirty-five patients who underwent BPTB ACL reconstruction with a minimum of 2 years follow-up evaluation were included in the study. Thirty BPTB autografts and five BPTB allografts were fixed with two biodegradable 2.7 mm cross pins (Rigid Fix) on the femoral side. Clinical evaluation included International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and Telos stress device measurements. The average Lysholm knee score was 94.7 (of 100). Twenty-four patients reported an excellent result. The other eight patients were in a good group. According to the IKDC scores, 23 (66%) patients reported normal function, 12 (34%) patients reported nearly normal function, and no (0%) patient reported abnormal or severely abnormal function. Telos stress device values were less than 3 mm of sagittal displacement in 28 patients and 5 mm in 7 patients. No patients complained that their knees gave way fully, even with moderate or strenuous activities. All of the patients have returned to their preinjury level of activity and athletic participation. Clinical results support this technique as a reliable alternative for patellar tendon fixation in ACL reconstruction.