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971.
Impact of reflux esophagitis on the esophageal function before and after laparoscopic fundoplication
Masato Hoshino Nobuo Omura Fumiaki Yano Kazuto Tsuboi Se Ryung Yamamoto Shunsuke Akimoto Takahiro Masuda Hideyuki Kashiwagi Katsuhiko Yanaga 《Esophagus》2018,15(4):224-230
Background
High-resolution manometry (HRM), which is breakthrough testing equipment to evaluate esophageal motor function, was developed in Europe and United State and has garnered attention. Moreover, multichannel intraluminal impedance pH (MII-pH) testing has allowed us to grasp all liquid/gas reflux including not only acid but also non-acid reflux. We examined the impact of the presence of reflux esophagitis (RE) on esophageal motor function before and after laparoscopic fundoplication.Materials and methods
The subjects included 100 patients (male: 63 patients, mean age: 54.1?±?15.8) among 145 patients who underwent laparoscopic fundoplication for GERD associated diseases during a 4-year period from October 2012 to September 2016, excluding 6 patients who underwent further surgery, 32 patients on whom HRM was not performed, 3 patients who had technical errors during testing, and 4 patients for whom the status of RE was unknown. Regarding HRM, Mano Scan from Given Imaging Ltd. was used, and for the analysis, Mano View version 3.0 from the same company was used, after which data was calculated based on the Chicago Classification advocated by Pandolfino et al. Moreover, for the MII-pH testing, Sleuth manufactured by Sandhill Scientific. Inc. was used and automatic analysis was conducted by a computer. Postoperative assessments were conducted 3 months following surgery for all. Data was described in the median value and inter-quartile range, with a statistically significant difference defined as p?<?0.05 by Chi square, Mann–Whitney, and Wilcoxon tests.Results
RE+?group (Los Angeles classification A:B:C:D?=?7:9:16:12 patients) included 44 patients (44%), of older age compared to the RE? group (62 vs. 50 years, p?=?0.012) and a higher Body Mass Index value (24.0 vs. 22.5, p?=?0.045); however, no differences were observed in terms of gender and duration of symptoms. In the preoperative findings on MII-pH, the RE+?group demonstrated significantly longer acid reflux time (4.7 vs. 1.3%, p?=?0.005), while in the HRM findings, the RE? group demonstrated a significantly longer abdominal esophagus (0 vs. 0.4 cm, p?=?0.049) and maintained esophageal body motor function (DCI: 1054 vs. 1407 mmHg s cm, p?=?0.021, Intact peristalsis ratio: 90 vs. 100%, p?=?0.037). As to the comparison of the treatment effect before and after laparoscopic fundoplication (Toupet fundoplication for all), significant improvements were observed in both groups in various parameters regarding reflux including acid reflux time, total number of liquid reflux episodes and total number of reflux episodes. Moreover, for both groups, the total length of the lower esophageal sphincter (LES) (RE+?group: 2.7 vs. 3.2 cm, p?=?0.001, RE? group: 3.0 vs. 3.4 cm, p?=?0.003) and the total length of the abdominal esophagus (RE+?group: 0 vs. 1.6 cm, p?<?0.001, RE? group: 0 vs. 1.8 cm, p?=?0.001) were significantly extended following surgery; however, no change was observed in DCI before and after surgery.Conclusions
Regardless of the presence of RE, cardiac function and LES function were improved following laparoscopic Toupet fundoplication, but no changes were observed in esophageal body motor function.972.
973.
Heart failure in women 总被引:1,自引:0,他引:1
Barnard DD 《Current cardiology reports》2005,7(3):159-165
Increasingly high mortality from cardiovascular disease in women has sparked nationwide campaigns to raise awareness of this
significant threat to women’s health. Heart failure has the most lethal prognosis of the major cardiovascular diseases, yet
women demonstrate an apparent survival advantage compared with men. Sex-linked disparities in heart failure risk factors and
pathophysiology contribute to this divergent clinical outcome. Heart failure etiology and clinical manifestations unique to
female sex exist. At age 40, the lifetime risk of developing heart failure is equal for men and women, whereas the lifetime
risk of developing coronary heart disease is one in two for men and one in three for women. Understanding sex-inherent characteristics
related to heart failure may help determine whether the optimal therapy for this prevalent syndrome should be modified according
to sex. Until prospective trial data prove otherwise, heart failure treatment guidelines should be uniformly applied to both
women and men. 相似文献
974.
The obesity gene product leptin plays an important role in the physiologic regulation of appetite and energy balance. Plasma
leptin levels correlate closely with body fat storage and may respond to changes in energy expenditure. Recent evidence has
implicated a direct cardiac regulatory action of leptin in addition to its well-established metabolic properties. Compelling
evidence has indicated a link between abnormal leptin levels (hyper-or hypoleptinemia) and cardiac dysfunction. The leptin-deficient
ob/ob mice have been used as a model for insulin resistance, obesity, and type 2 diabetes. Leptin replenishment has been shown
to restore the depressed cardiac contractile function in ob/ob mice, indicating a permissive role of leptin in cardiac function. The precise role of leptin or leptin deficiency on cardiac
health has not been fully elucidated. This article briefly reviews leptin’s physiologic role in cardiomyocyte structure and
function and how leptin deficiency or disrupted signaling may trigger cardiac functional and morphologic abnormalities. 相似文献
975.
Ankylosing spondylitis in the pharaohs of ancient Egypt 总被引:1,自引:0,他引:1
BACKGROUND: Among the pharaohs of the 18th and 19th dynasty of Old Egypt, at least three had ankylosing spondylitis: Amenhotep (Amenophis) II, Ramses II ("The Great"), and his son Merenptah. OBJECTIVE: An illustrated review is given on the radiological indications for their disease, together with the rough history of these pharaohs, the history of their tombs, of the detection of their mummies in the 19th century and of their paleopathological investigation. 相似文献
976.
We examined the association between serum trace elements and clinical findings such as number of sensitive tender points, severity of fatigue and functional status in patients with fibromyalgia (FM). Thirty-two patients diagnosed as having FM according to the ACR 1990 criteria and 32 normal healthy controls (NHC) were included in this study. The demographic data, disease duration, number of tender points and accompanying symptoms (fatigue, sleep disorders, headache, paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud's phenomena) of the patients were noted. Visual analog scale (10 cm) was implemented to estimate daily severity of pain and fatigue. Fibromyalgia impact questionnaire was used for functional assessment. Serum selenium (mug/dL) and serum zinc (mug/dL) levels were measured by atomic absorption spectrometer. Serum magnesium (mmol/L) level was measured by the original kits of Abbott Aeroset auto-analyzer. The mean age of patients in FM group and NHC were calculated as 42.9 (SD = 7.7) years and 41.3 (SD = 9.7) years, respectively. Serum levels of zinc (P = 0.001) and magnesium (P = 0.002) were significantly decreased by FM groups, whereas there was no considerable difference with selenium levels of both groups (P > 0.05). Association between serum zinc level and number of tender points (P = 0.008) and that between fatigue and magnesium level (P = 0.003) was found as meaningful. According to the results of this study, it was asserted that serum magnesium and zinc levels may play an important role in the pathophysiology of FM. 相似文献
977.
978.
979.
The pathology of ductal-type pancreatic carcinomas and pancreatic intraepithelial neoplasia: Insights for clinicians 总被引:3,自引:0,他引:3
The phenotypic classification of pancreatic neoplasms is based on their cellular lineage. Thus, tumors with a ductal, acinar,
and endocrine phenotype can be distinguished. Most pancreatic neoplasms show a ductal phenotype and can be classified as ductal
adenocarcinomas. Less common tumors with a ductal phenotype are the variants of ductal adenocarcinoma, intraductal papillary
mucinous neoplasm (including colloid carcinoma), mucinous cystic neoplasm, medullary carcinoma, and other rare tumors. Ductal
adenocarcinomas most likely develop from ductal proliferative lesions arising in the pancreatic duct system. A recently adopted
classification system for these lesions distinguishes between three grades of pancreatic intraepithelial neoplasia (PanIN).
Molecular studies have revealed that PanIN-2 and PanIN-3 lesions represent a distinct step toward invasive carcinoma. 相似文献
980.
Mechanisms of Action and Resistance of Somatostatin Analogues for the Treatment of Hepatocellular Carcinoma: A Message Not Well Taken 总被引:1,自引:0,他引:1
Samonakis DN Notas G Christodoulakis N Kouroumalis EA 《Digestive diseases and sciences》2008,53(9):2359-2365
Somatostatin (SST) acts as an inhibitory peptide of various secretory and proliferative processes. Apart from neuroendocrine tumors, where SST analogues have an established role, they have been tested in other tumors such as hepatocellular carcinoma (HCC) in the view of the fact that chemotherapy is not working. Several positive reports have been published. Approximately 40% of patients respond with improved survival and an impressive quality of life. A usual misunderstanding in trial designs is that, although SST is not a rescue drug, selection of patients is inappropriate, with mostly moribund patients being recruited. SST analogues do not seem to work in 60% of HCCs and this has been linked to the presence of SST receptors (SSTR) in the tumor, while several resistance mechanisms might be involved. Future management should engage more specific SST analogues targeted to a tumor with a known SSTR map. The use of somatostatin analogues as an adjunct therapy in combination with other treatment modalities should also be investigated. 相似文献