Biopsy site for detecting Helicobacter pylori infection in patients with gastric cancer

Background:  Helicobacter pylori eradication is recommended in post-gastric cancer resection, but premalignant changes may prevent the detection of H. pylori . The aim of this study was to determine appropriate biopsy site for detecting H. pylori in gastric cancer patients.
Materials and Methods:  Consecutive patients (194) with gastric adenocarcinoma were prospectively enrolled. Helicobacter pylori was evaluated by serology, histology and rapid urease test. Biopsy sites included antrum lesser curvature, upper body lesser curvature (UBLC) and upper body greater curvature (UBGC). Two biopsy specimens were obtained from each site for histological examination. One additional specimen was obtained from UBGC for the rapid urease test.
Results:  The overall infection rate of H. pylori was 84.0% (95% CI 78.9–89.2). The sensitivity of histology for detecting H. pylori at various sites was: antrum (54.9%; 95% CI 45.7–63.9), UBLC (80.3%; 95% CI 72.2–87.0) and UBGC (95.1%; 95% CI 89.6–98.2). Specificities of all three biopsy sites were more than 95%. Sensitivity and specificity of the rapid urease test performed at UBGC were 96% and 100%, respectively. Sensitivities of histology decreased in correlation with increasing severity of atrophy and intestinal metaplasia (both P  < 0.001 using the chi-square test for trend). The proportions of moderate to marked atrophy/intestinal metaplasia at UBGC (12.8%/14.7%) were significantly lower than those at antrum (50.0%/57.8%, P  < 0.001 respectively) or UBLC (40.0%/48.9%, P  < 0.001 respectively).
Conclusions:  The UBGC side is the most sensitive and specific biopsy site to detect H. pylori in gastric cancer patients due to less frequent atrophy and intestinal metaplasia than at the antrum or UBLC side.     

Extrahepatic biliary schwannomas: a case report

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature.     

A propensity score-matched comparison of recurrence outcomes after immediate implant vs autologous flap reconstruction in patients receiving neoadjuvant chemotherapy for breast cancer

Breast Cancer Research and Treatment - We compared oncologic outcomes between breast cancer patients who underwent immediate implant-based breast reconstruction (IBBR) and those who underwent...     

Epidemiological Trends of Pediatric Inflammatory Bowel Disease in Korea: A Multicenter Study of the Last 3 Years Including the COVID-19 Era

BackgroundStudies on how the coronavirus pandemic has affected pediatric inflammatory bowel disease (PIBD) are lacking. We aimed to investigate the trends in epidemiology, characteristics, initial management, and short-term outcomes of PIBD in South Korea over the recent three years including the era of coronavirus disease 2019 (COVID-19).MethodsThis multicenter study retrospectively investigated temporal trends in the epidemiology of PIBD in Korea. Annual occurrences, disease phenotypes, and initial management at diagnosis were analyzed from January 2018 to June 2021.ResultsA total of 486 patients from 17 institutions were included in this epidemiological evaluation. Analysis of the occurrence trend confirmed a significant increase in PIBD, regardless of the COVID-19 pandemic. In Crohn’s disease, patients with post-coronavirus outbreaks had significantly higher fecal calprotectin levels than those with previous onset (1,339.4 ± 717.04 vs. 1,595.5 ± 703.94, P = 0.001). Patients with post-coronavirus-onset ulcerative colitis had significantly higher Pediatric Ulcerative Colitis Activity Index scores than those with previous outbreaks (48 ± 17 vs. 36 ± 15, P = 0.004). In the initial treatment of Crohn’s disease, the use of 5-aminosalicylic acid (5-ASA) and steroids significantly decreased (P = 0.006 and 0.001, respectively), and enteral nutrition and the use of infliximab increased significantly (P = 0.045 and 0.009, respectively). There was a significant increase in azathioprine use during the initial treatment of ulcerative colitis (P = 0.020).ConclusionRegardless of the COVID-19 pandemic, the number of patients with PIBD is increasing significantly annually in Korea. The initial management trends for PIBD have also changed. More research is needed to establish appropriate treatment guidelines considering the epidemiological and clinical characteristics of Korean PIBD.     

Bridging mandibular continuity defects with miniplates: an experimental study.

Various miniplate fixation techniques were studied in dogs to determine whether the use of miniplate fixation provides sufficient stability in mandibular continuity defects. Continuity resections measuring 15 mm were made on the mandibles of 16 dogs and were bridged using 4 miniplate fixation techniques, each replicated 4 times. All dogs were placed on a normal diet throughout the postoperative period. Clinical and radiological examinations were carried out 6 weeks later. We found that the group with both double miniplates and bicortical screws was stable, whereas the groups utilizing either a single miniplate or monocortical screws were not. The results of this study indicate that using a combination of double miniplates and bicortical screws to bridge defects after mandibular resection produces stable and predictable results.     

N-Alkylierungen unsymmetrischer Piperazine

N-Alkylations of Unsymmetric Piperazines Unsymmetrically 1,4-disubstituted piperazines can be N-(or N'-)mono- or N,N'-bisalkylated. If the two substituents differ in size sufficiently, monoalkylations occur regiospecifically.     

Open repair and arthroscopic follow-up of severely delaminated femoral head cartilage associated with traumatic obturator fracture-dislocation of the hip

This article describes an unusual case of a young adult with traumatic obturator fracture-dislocation of the hip, involving a large femoral head fragment and severe delamination of articular cartilage. The dislocation was irreducible by closed reduction because of interposing soft tissues, including the rectus femoris and iliopsoas muscles, and torn joint capsules, and therefore, open reduction was performed using an anterolateral approach in the lateral decubitus position. The large femoral head fragment was released from the ligamentum teres and fixed to the dislocated femoral head with headless screws. The severely delaminated femoral head cartilage was repaired with suture anchors and absorbable sutures. The patient was kept nonweight bearing for 6 weeks postoperatively, and was then allowed to resume full weight bearing gradually. He returned to normal activities of daily living at 14 weeks. At 9 months postoperatively, arthroscopic examination showed complete healing of the fracture and cartilage lesions, and at 12-month follow-up, there was no clinical or radiographic evidence of arthritis or osteonecrosis. The patient had no pain or limp, and achieved an excellent result according to Epstein's clinical evaluation criteria. To our knowledge, no previous report exists on the arthroscopic follow-up of a repaired femoral head cartilage in patients with obturator fracture-dislocation of the hip along with a large femoral head fragment and severe delamination of articular cartilage.