Eosinophilic esophagitis in adults: a systematic review

BACKGROUND/AIMS: Eosinophilic esophagitis (EE) is an increasingly recognized condition both in children and adults. The aim of the present study was to review the available evidence regarding EE in adults. METHODS: PubMed, MEDLINE and medical textbooks were searched in May-June 2005 for English-language articles published between January 1978 and June 2005 containing relevant terms. The abstracts of two major conferences from 2000 to June 2005 were also reviewed. The presence of more than 15 eosinophils per high power field on esophageal biopsies was required to establish the diagnosis. RESULTS: Twenty-four studies with 325 patients (male/female ratio: 3/1) were found that met the review criteria. Presenting symptoms included dysphagia (93%), food impaction (62%) and heartburn (23.6%). An allergic history and peripheral eosinophilia was noted in 51.6 and 30.8% of patients, respectively. Esophageal manometry presented evidence of a motility disorder in 40% of cases. Endoscopic findings included mucosal fragility/oedema, rings, strictures, whitish pinpoint exudates and small-calibre esophagus in 59.3, 49.2, 39.7, 15.7 and 5.3% of cases, respectively, whereas 8.8% of patients had a normal endoscopy. Bougienage was performed in 64 patients, with limited efficacy and an increased complication rate. The administration of corticosteroids resulted in symptomatic improvement in more than 95% of cases. CONCLUSIONS: An allergic history and peripheral eosinophilia is less common in adults than among children with EE. An esophageal motility disorder should be a novel indication for biopsies in adults with long-lasting dysphagia. A trial with corticosteroids before bougienage may reduce active inflammation and the complication rate.     

Prediction of peak oxygen uptake from a maximal treadmill test in 12- to 18-year-old active male adolescents

The aims were to develop and validate a VO(2peak) prediction equation from a treadmill running test in active male adolescents. Eighty-eight athletes (12-18 yrs.) performed a maximal exercise test on a treadmill to assess the actual VO2peak and a 20m Shuttle-Run-Test (20mST). A step-wise linear regression analysis was used and the following equation for estimation of VO(2peak) (mL·kg?1·min?1) = 35.477 + 1.832 × duration in min - 0.010 × duration × body mass in kg was developed. The cross-validation statistics were: R = .54, CE = 0.1 mL·kg?1min?1, SEE = 2.5 mL·kg?1·min?1 (4.6%), and TE = 2.6 mL·kg?1·min?1 (4.9%). The cross-validation values (CE, SEE, and TE) were lower compared with those of previously published equations in adolescents that estimated VO(2peak) using anthropometric data, performance in 20mST, and energy cost at submaximal speeds.     

Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment

OBJECTIVE: To evaluate the radiographic and clinical outcome, including the incidence of recurrence, in patients with displaced greater tuberosity (GT) fractures associated with a traumatic anterior shoulder dislocation. DESIGN: Retrospective study. SETTING: University Hospital (Level 1 trauma center). PATIENTS: There were 34 completely evaluated patients (19 male, 15 female) seen between 1993 and 2002 with a displaced GT fracture associated with a traumatic anterior shoulder dislocation. Average age was 52.8 years and the mean follow-up period was 4.8 years (range, 2.0 to 10 years). INTERVENTION: All GT fractures were internally fixed solely with heavy non-absorbable sutures and any associate rotator cuff tear was repaired at the same time. A special rehabilitation protocol was administered in all patients. MAIN OUTCOME MEASUREMENTS: Functional assessment was obtained using the parameters of the Constant score which grades outcomes as excellent, very good, good and poor. RESULTS: Overall, there were 25 (73.5%) excellent, 6 (17.6%) very good, 2 (5.8%) good and 1 (3.1%) poor results, and the average Constant score was 88.4 (range 45.0 to 100.0). All fractures healed radiographically, without evidence of secondary displacement, except in one patient. No case of recurrence of dislocation was noted in any patient. Partial absorption or "lysis" of the GT without significant clinical relevance was detected in 4 cases. CONCLUSIONS: Displaced fractures of the GT after traumatic anterior shoulder dislocation may result in limitation of motion and functional disability if they are not treated promptly by surgery. Open reduction and stable fixation of the GT along with rotator cuff repair when present, allows for early passive motion of the joint, and yields excellent final results in approximately three quarters of the patients and restores their ability to return to full activities of daily living. A compliant patient is also necessary for a successful result.     

Orbital metastasis from verrucous carcinoma of the oral cavity: case report and review of the literature

A rare case of metastatic verrucous carcinoma (VC) of the oral cavity is presented. The patient was referred to the Ophthalmology Department due to diplopia. The patient reported history of diagnosis of verrucous squamous carcinoma in the oral cavity occuring 6 years earlier that although excised presented several recurrences. The lesion metastasized to local lymph nodes and after being characterized as inoperable the patient underwent thirty-seven sessions of radiation therapy. Two months after completion of radiation therapy, the patient underwent an orbital CT scan that revealed a mass with morphological features consistent with secondary involvement of the orbit from the known VC. Although treated with chemotherapy, the patient died 5 months later. No other case of this entity, which usually presents as a slow-growing lesion enlarging with direct extension rather than frank invasion, metastasizing to the orbit has been reported in relevant literature.     

Clamp–crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms

Background:

Several techniques for liver resection have been developed. We compared radiofrequency-assisted (RF) and clamp–crush (CC) liver resection (LR) in terms of blood loss, operating time and short-term outcomes in primary and metastatic tumour resection.

Methods:

From 2002 to 2007, 196 consecutive patients with primary or metastatic hepatic tumours underwent RF-LR (n= 109; group 1) or CC-LR (n= 87; group 2) in our unit. Primary endpoints were intraoperative blood loss (and blood transfusion requirements) and total operative time. Secondary endpoints included postoperative complications, mortality and intensive care unit (ICU) and hospital stay. Data were collected retrospectively on all patients with primary or secondary liver lesions.

Results:

Blood loss was similar (P= 0.09) between the two groups of patients with the exception of high MELD score (>9) cirrhotic patients, in whom blood loss was lower when RF-LR was used (P < 0.001). Total operative time and transection time were shorter in the CC-LR group (P= 0.04 and P= 0.01, respectively), except for high MELD score (>9) cirrhotic patients, in whom total operation and transection times were shorter when RF-LR was used (P= 0.04). Rates of bile leak and abdominal abscess formation were higher after RF-LR (P= 0.04 for both).

Conclusions:

Clamp–crush LR is reliable and results in the same amount of blood loss and a shorter operating time compared with RF-LR. Radiofrequency-assisted LR is a unique, simple and safe method of resection, which may be indicated in cirrhotic patients with high MELD scores.     

Hypergastrinemia is associated with increased risk of distal colon adenomas

BACKGROUND/AIMS: Helicobacter pylori infection is a recognized cause of hypergastrinemia, but the association of blood gastrin levels with colonic adenomas (CAs) is controversial. The aim of this study is to investigate if hypergastrinemia, H. pylori infection and/or cagA protein are risk factors for CAs. METHODS: In this prospective case-control study, fasting serum samples from 78 consecutive patients with CAs and 78 demographically matched colonoscopy-negative controls were assayed for anti-H. pylori immunoglobulin G, cagA protein and serum gastrin levels. Multivariate analysis was performed to identify risk factors for colon adenomas. RESULTS: Though prevalence of H. pylori antibodies was not significantly different, the prevalence of cagA protein was significantly higher in patients with adenomas (42.3%) as compared with controls (25.6%, p < 0.03). Mediangastrin levels were significantly higher in patients with CAs (55, 20-975 pg/ml) than in controls (45.2, 23-529 pg/ml) (p < 0.001). Hypergastrinemia (>110 pg/ml) was commoner in patients with CAs than in controls (29.5 vs. 11.5%, p = 0.006) and was the only independent risk factor for adenomas (odds ratio 3.2, 95% CI 1.4-7.5) by multivariate analysis, but not H. pylori infection or cagA positivity. There was a significant association of hypergastrinemia and distal distribution of adenomas (p < 0.002). CONCLUSIONS: Our study shows that hypergastrinemia is a risk factor for CAs, especially of the distal colon.     

DNA sequence analysis of GJB2, encoding connexin 26: observations from a population of hearing impaired cases and variable carrier rates, complex genotypes, and ethnic stratification of alleles among controls

Mutations in GJB2 are associated with hereditary hearing loss. DNA sequencing of GJB2 in a cohort of hearing impaired patients and a multi-ethnic control group is reported. Among 610 hearing impaired cases, 43 DNA sequence variations were identified in the coding region of GJB2 including 24 mutations, 8 polymorphisms, 3 unclassified variants (G4D, R127C, M163V), 1 controversial variant (V37I), and 7 novel variants (G12C, N14D, V63A, T86M, L132V, D159, 592_600delinsCAGTGTTCATGACATTC). Sixteen non-coding sequence variations were also identified among cases including the IVS1+1A>G mutation, 2 polymorphisms, and 13 novel variants. A diagnosis of GJB2-associated hearing loss was confirmed for 63 cases (10.3%). Heterozygous mutations were found in 39 cases (6.4%). Eleven cases carrying novel or unclassified variants (1.8 %) and 18 cases carrying the controversial V37I variant were identified (3%). In addition, 294 control subjects from 4 ethnic groups were sequenced for GJB2. Thirteen sequence variations in the coding region of GJB2 were identified among controls including 2 mutations, 6 polymorphisms, 2 unclassified variants (G4D, T123N), 1 controversial variant (V37I), and 2 novel variants (R127L, V207L). Nine sequence variations were identified among controls in the non-coding regions in and around GJB2 exon 2. Of particular interest among controls were the variability in carrier rates and ethnic stratification of alleles, and the complex genotypes among Asians, 47% of whom carried two to four sequence variations in the coding region of GJB2. These data provide new information about carrier rates for GJB2-based hearing loss in various ethnic groups and contribute to evaluation of the pathogenicity of the controversial V37I variant.     

Design of a multi-classifier system for discriminating benign from malignant thyroid nodules using routinely H&E-stained cytological images

A multi-classifier diagnostic system was designed for distinguishing between benign and malignant thyroid nodules from routinely taken (FNA, H&E-stained) cytological images. To construct the multi-classifier system, several combination rules and different mixtures of ensemble classifier members, employing morphological and textural nuclear features, were comparatively evaluated. Experimental results illustrated that the classifier combination k-NN/PNN/Bayesian and the majority vote rule enhanced significantly classification accuracy (95.7%) as compared to best single classifier (PNN: 89.6%). The proposed system was designed with purpose to be utilized in daily clinical practice as a second opinion tool to support cytopathologists' decisions, when a definite diagnosis is difficult to be obtained.