Symptomatic renal metastasis 5 years after the management of a squamous cell carcinoma of the lung

A case of solitary renal metastasis five years after the management of a primary squamous cell carcinoma of the lung is presented.     

Pyloric gland metaplasia and pouchitis in patients with ileal pouch‐anal anastomoses

Aliment Pharmacol Ther 31 , 862–873

Summary

Background Diagnosis and management of chronic antibiotic‐refractory pouchitis and Crohn’s disease of the pouch can be challenging. Pyloric gland metaplasia is a histological feature indicative of chronic mucosal inflammation. Its value in diagnosis and prognosis of pouch disorders has not been investigated. Aim To assess the prevalence, diagnostic and prognostic value, and risk factors of pyloric gland metaplasia in pouch patients. Methods Patients were identified from our prospectively maintained Pouchitis Database. Pouch biopsy specimens were re‐reviewed for pyloric gland metaplasia and other histological features. Two cohorts of patients were studied: a historical cohort (n = 111) and the second, a validation cohort (n = 100). Univariate and multivariate analyses were performed to assess risk factors for pyloric gland metaplasia. Results The prevalence of pyloric gland metaplasia in the historical cohort and validation cohort was 45 (40.1%) and 24 (24.0%), respectively. The sensitivity and specificity of pyloric gland metaplasia for the diagnosis of chronic antibiotic‐refractory pouchitis or Crohn’s disease were 70.7% and 92.5%, respectively, for the first cohort and 39.0% and 86.4%, respectively, for the 2^nd validation cohort. In multivariate analysis of the first cohort, patients with refractory pouchitis or Crohn’s disease were 28 times (95% CI, 7.3–107.1) more likely to have pyloric gland metaplasia than those with a normal pouch or irritable pouch syndrome. The factor of refractory pouchitis or Crohn’s disease remained in the model for the 2^nd validation cohort with odds ratio of 4.58 (95% CI, 1.6–13.4). Conclusions Pyloric gland metaplasia is associated with diagnosis of chronic antibiotic‐refractory pouchitis or Crohn’s disease of the pouch and appears to be a specific marker for both disease entities.     

Aortic Elastic Properties of Patients with Neurocardiogenic Syncope

Objective: Neurocardiogenic syncope (NCS) is a common clinical problem; however, hemodynamic mechanism is not clearly understood. Aim of the present study was to investigate aortic elastic parameters of patients with NCS provoked by head‐up tilt test. Material and Method: We conducted a prospective study of 40 cases referred to our institution for head‐up tilt testing. Group I constituted as 22 patients who developed mixed response and were enrolled for analysis. Hemodynamic data were compared with subjects of negative head‐up tilt test (Group II). Aorta‐diastolic and aorta‐systolic diameters, aortic strain, aortic distensibility, aortic elastic modulus, and aortic stiffness index were calculated from transthoracic echocardiographically derived diameters of thoracic aorta. Results: Aortic distensibility (mean ± SD; 2.7 ± 1.2 cm²× dyn^?1× 10^?6 vs 4.0 ± 1.2 cm²× dyn^?1× 10^?6, P = 0,003) and aortic strain index (mean ± SD; 7.0 ± 1.8% vs 8.7 ± 2.9%, P = 0.042) were lower, and aortic stiffness index (mean ± SD; 27.6 ± 10.9 vs 20.9 ± 6.18, P = 0.035) and aortic elastic modulus (mean ± SD; 0.94 ± 0.7 cm²× dyn^?1× 10^?6 vs 0.49 ± 0.1 cm²× dyn^?1× 10^?6, P = 0.009) were higher in patients in Group I compared with those in Group II. There was no difference between two groups for following clinical variables: aorta‐diastolic and aorta‐systolic diameters, systolic and diastolic blood pressure, pulse pressure, E/A, weight, height, and body mass index. Conclusions: Findings of this study have shown that elastic properties of aorta are impaired in patients with NCS. The data suggest that increase in aortic stiffness might be one of the determinants responsible for NCS. This proposal of novel link should be confirmed in further studies.     

Evaluation of a New Rate Adaptive Ventricular Pacemaker Controlled by Double Sensors

The LEGEND-PLUS, a new rate adaptive pacemaker that combines activity and minute ventilation sensing for automatic rate adaptation was implanted in the right ventricle (VVIR) in 11 patients (mean age 62 ± 9 years). Initial programming was performed using the Programmer Exercise Protocol (a 3-minute walk). This programming was evaluated by treadmill tests, up-stairs and down-stairs walking, and Holier recordings. Results: Following the final programming of LEGEND-PLUS, the mean upper activity rate was 102 ± 7 beats/rain (range 90–120 beats/min), while the mean upper minute ventilation rate was 125 ± 16 beats/min (range 100–150 beats/min). The mean rate responses during the exercise protocol and the final programming in minute ventilation and activity sensing modes were 5.4 ± 2.3 (range 1–9), versus 4 ± 2.4 (range 1–8; P < 0.01) and 7.6 ±1.1 (range 5–9), versus 7.5 ± 0.8 (range 6–9; P = 0.8), respectively. In the combined sensing mode, the acceleration rate was identical to the activity rate response and the deceleration rate mimicked the minute ventilation. Conclusion: Dual sensor VVIR pacemakers have the potential to improve rate adaptation to exercise. The rate response to exercise in patients fitted with activity and minute ventilation sensors, VVIR pacemakers closely mimics the physiological rate response.     

Influence of Electromagnetic Fields on Bone Fracture in Rats: Role of CAPE

Objective To study the effects of radiation emitted by mobile phones on bone strength and caffeic acid phenethyl ester （CAPE） on the changes induced by radiation. Methods Forty-eight Sprague-Dawley rats were divided into five groups. Rats in the control group （first group） were left within the experimental setup for 30 min/day for 28 days without radiation exposure. Nine hundred MHz radiation group was broke down into 2 subgroups （group 1/2）. Both subgroups were exposed to radiation for 28 days （30 min/day）. The next group was also divided into 2 subgroups （group 3/4）. Each was exposed to 1800 MHz of radiation for 28 days （30 mirdday）. The third and fifth groups were also treated with CAPE for 28 days. Treatment groups received ip caffeic acid phenethyl ester （10 ktmol/kg per day） before radiation session. Bone fracture was analyzed. Results Breaking force, bending strength, and total fracture energy decreased in the irradiated groups but increased in the treatment groups. Conclusion Radiation and CAPE can significantly improve bone.     

Undersensing of the Tiny QRS Complexes That Emerged After the Isolation of the Right Ventricle in a Patient with Ventricular Tachycardia

This article describes a patient who underwent right ventricular disconnection for medically refractory ventricular tachycardia associated with arrhythmogenic right ventricular dysplasia. After the operation there was no ventricular tachycardia recurrence. Two years after the operation, he received a permanent VVI pacemaker for the symptomatic second-degree AV block. Sensing function of the pacemaker was normal for the normal QRS complexes, but the tiny QRS complexes that appeared after the arrhythmia surgery were not sensed by the pacemaker and therefore caused no problem.     

肝功能衰竭患者的胃肠道手术

肝功能衰竭患者非肝脏手术后的发病和死亡风险较非肝功能衰竭患者增高。肝硬化患者急诊手术后死亡率高于择期手术后。对接受非肝脏手术的肝功能衰竭患者行术前评估极为重要，可降低高术后并发症和死亡风险。     

Administration of adalimumab in the treatment of Crohn's disease of the ileal pouch

Background  Crohn's disease (CD) of the pouch can develop in patients with ileal pouch-anal anastomosis (IPAA). Scant data are available on the treatment of this disease entity.
Aim  To evaluate efficacy and safety of adalimumab in treating CD of the ileal pouch.
Methods  From June 2007 to June 2008, 17 IPAA patients with inflammatory ( n  = 10), fibrostenotic ( n  = 2) or fistulizing ( n  = 5) CD of the pouch treated with adalimumab were evaluated. Inclusion criteria were CD of the pouch who failed medical therapy and were otherwise qualified for permanent pouch diversion or excision. All qualified patients received the standard dosing regimen of subcutaneous injection adalimumab (160 mg at week 0, 80 mg at week 1, and 40 mg every other week thereafter). Complete clinical response was defined as resolution of symptoms. Partial clinical response was defined as improvement in symptoms. Endoscopic inflammation before and after therapy was recorded, using the Pouchitis Disease Activity Index (PDAI) endoscopy subscores.
Results  The median age was 36 years with 12 patients (70.6%) being male. At 4 weeks, seven patients (41.2%) had a complete symptom response and 6 (35.3%) had a partial response. There was also a significant improvement in the PDAI endoscopy subscores at week 4 ( P  <   0.05). At the last follow-up (median of 8 weeks), eight patients (47.1%) had a complete symptom response and 4 (23.5%) had a partial response. Four patients (23.6%) developed adverse effects. Three patients (17.7%) eventually had pouch failure after failing to respond to adalimumab therapy.
Conclusion  Adalimumab appeared to be well-tolerated and efficacious in treating CD of the pouch in this open-labelled induction study.