Esophageal achalasia and pregnancy: own observations in 43 patients and a review of the literature

Introduction

Little is known concerning the interaction of achalasia and pregnancy and about an optimal time and type for treatment. Achalatic women of our collective of patients with at least one pregnancy in their history resulting in confinement or miscarriage were invited for a structured interview.

Materials and methods

43 of 109 female patients were included. Questionnaire contained questions on symptoms, type of symptoms, whether patients could link a specific event with outbreak of disease. Date of primary diagnosis and individual therapies were double checked against our documentation as well as duration of complaints and kind of therapy. Patients were asked about their obstetric history, whether and how symptoms had changed, and during which pregnancy week symptoms have occurred. Temporal correlation of the diagnosis of achalasia and pregnancy was investigated.

Results

There was no relationship between pregnancy and onset of achalasia. Risk of subfertility, undernourishment, premature birth, or miscarriage does not seem to be increased in achalasia. Health condition often worsened significantly during pregnancy, mainly in the first trimester and particularly in the untreated patients.

Conclusions

It is advisable to clarify the diagnosis if symptoms suspicious of an achalasia are present before a planned pregnancy. In case of manifest achalasia, surgical treatment should be performed before pregnancy and the improvement in the state of health should be anticipated, as, otherwise, a considerable deterioration of the symptoms during pregnancy may occur. Scientific impact of our observations is very limited and prospective clinical trials are required.

     

Freeze‐drying as a preserving preparation technique for in vitro testing of human skin

In vitro testing of drugs with excised human skin is a valuable prerequisite for clinical studies. However, the analysis of excised human skin presents several obstacles. Ongoing drug diffusion, microbial growth and changes in hydration state influence the results of drug penetration studies. In this work, we evaluate freeze‐drying as a preserving preparation method for skin samples to overcome these obstacles. We analyse excised human skin before and after freeze‐drying and compare these results with human skin in vivo. Based on comprehensive thermal and spectroscopic analysis, we demonstrate comparability to in vivo conditions and exclude significant changes within the skin samples due to freeze‐drying. Furthermore, we show that freeze‐drying after skin incubation with drugs prevents growth of drug crystals on the skin surface due to drying effects. In conclusion, we introduce freeze‐drying as a preserving preparation technique for in vitro testing of human skin.     

Decreasing Oxidative Stress with Choline and Carnitine in Women

Objective: Fatty acid oxidation is predominantly a mitochondrial event, which is enhanced by dietary choline and carnitine supplementation resulting in extra reactive oxygen species (ROS) load. The objective was to assess oxidative stress level by thiobarbituric acid reactive substances [TBARS] in choline and carnitine supplemented healthy women before and after mild exercise.

Methods: Nineteen free-living women completed the placebo control study in which choline and/or L-carnitine was orally taken for 21 days. Anthropometric measurements, dietary recall, exercise routine and blood samples were analyzed to determine body composition, nutrients intake, distance walked and biochemical markers related to oxidative stress.

Results: TBARS were significantly lower in the groups supplemented with choline, carnitine or both and the mild exercise (walking) was not a deterrent in this effect of the supplements. Serum vitamin A and E concentrations were higher in the supplemented groups even though the consumption of these nutrients was not different among the groups.

Conclusion: Choline and carnitine supplementation lowers lipid peroxidation, and promotes conservation of retinol and α-tocopherol in free-living women.     

Accelerated hyperfractionated radiotherapy within trimodality therapy concepts for stage IIIA/B non-small cell lung cancer: Markedly higher rate of pathologic complete remissions than with conventional fractionation

BackgroundRadiation dose escalation within definitive radiochemotherapy (RTx/CTx) was not successful for stage III non-small cell lung cancer (NSCLC) using conventional fractionation (CF). Accelerated-hyperfractionation (AHF) counteracts tumour cell repopulation. In this observational study, the effects of neoadjuvant RTx/CTx using AHF or CF were studied by histopathology and using the survival end-point.MethodsData from all consecutive lung cancer patients treated with neoadjuvant RTx/CTx and thoracotomy between 08/2000 and 06/2012 were analysed. Patients received induction chemotherapy (cisplatin-doublets) followed by concurrent RTx/CTx using AHF (45 Gy/1.5 Gy bid) or CF-RTx (46 Gy/2 Gy qd). For estimating the AHF versus CF treatment effects, multivariate analysis (MA), propensity score weighting (PS), and instrumental variable analysis (IV) were used.Findings239 patients were treated, median age 58 (34–78) years, stage II/IIIA/B: 19/88/132, squamous cell/adenocarcinomas/other: 98/107/34; AHF/CF-RTx 112/127 patients. No significant differences between both groups, in tumour related factors (age, gender, Charlson comorbiditiy score, lactate dehydrogenase (LDH), haemoglobin, stage, histopathology and grading), existed. Crude rates of pathologic complete responses (pCR) in AHF and CF groups were 37% and 24% respectively. The dose fractionation effect on pCR was significant (p ? 0·006, PS and IV analyses). There was a significant dependence of pCR on biologically effective dose. pCR also depended on treatment time (MA, p = 0·04; PS, p = 0·0004). Median treatment time was 22 d or 31 d using AHF or CF (p < 0.0001), respectively. Adenocarcinomas had lower pCR rates in comparison to other histologies. Five-year survival of patients with pCR was 65%, independent of the fractionation.InterpretationThis large monoinstitutional analysis demonstrates an increased effect of AHF on pCR of lung cancer which modifies overall survival.     

Operationalization of the clinical head and neck examination

Standardized procedures support learning of complex psychomotoric activities. We standardized the clinical otolaryngology examination to provide an objective basis for its operationalization. The Impact of the standardization on the objective measureable learning success and the student's evaluation were determined.During their 1-week ENT internship 166 medical students learned the standardized clinical otolaryngology examination. At the end of this week they absolved an objective structured clinical examination (OSCE). The students evaluated both, the teaching (standardization) and examination method (OSCE) with 2 questionnaires.All students passed the exam with mean score of 60.3±3.5 (max. 65) points. By using the OSCE checklist 2 independent examiners appraised nearly identical examination performances. In both evaluations the students rated the teaching and examination design positive. All students greatly appreciated the standardized clinical examinations and considered it as are very important for learning practical skills.The standardization of clinical otolaryngology examination permits objective and reliable tests for learning progress and success. Furthermore transparency, process reliability and test quality are considerably improved. The student's evaluation clearly reflects the mentioned advantages.