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Esophageal motility disorders in the rheumatic diseases: a review of 150 patients.

OBJECTIVE: Rheumatic diseases are a group of systemic disorders that may be concurrent with Raynaud's phenomenon and involvement of the internal organs, in particular the esophagus. Esophageal motor abnormalities have been widely described in systemic sclerosis, but have not frequently been reported in other diseases. In the present study we have examined the prevalence and pattern of esophageal motility disorders in different rheumatic diseases. METHODS: Esophageal manometry was performed on 150 patients, 21 males and 129 females, suffering from different rheumatic diseases (SSc, RA, SLE, MCTD, undifferentiated CTD, or DM/PM) and on 30 healthy controls. RESULTS: Functional involvement of the esophagus was demonstrated in all the rheumatic diseases considered, although at varying percentages. The frequencies of the functional abnormalities differed when each disease was considered separately. In SSc patients abnormalities were found more frequently in the lower esophageal sphincter (81.8%) and in the esophageal body (84.8%); data for the DM/PM and MCTD patients broadly overlapped. On the contrary, in SLE the lower sphincter appeared to be less (or even not at all) impaired, while the most specific disorder was an isolated abnormal peristalsis. RP did not always correlate with manometric changes in all of the groups studied. CONCLUSIONS: Three conclusions derive from our study: i) motor disorders affecting the esophagus were not only found in SSc, but also in all forms of non-lupus CTD; ii) the simultaneous involvement of the esophageal body and the lower esophageal sphincter is discriminant between non-lupus CTD and SLE; and iii) RP may be regarded as a condition pathogenetically unrelated to manometrically detected esophageal motor abnormalities.

Adolescent↗

[Smoking cessation during treatment of alcohol dependence in drug and alcohol rehabilitation centres--a review].

PURPOSE: Review of the international literature on smoking cessation with smokers having a concurrent alcohol abuse disorder. The three aims are: 1. discussion of the pros and cons of concurrent smoking cessation and treatment of alcohol use disorder, 2. smoking cessation strategies and 3. description of national and international studies evaluating smoking cessation interventions with patients who are at the same time treated for their alcohol abuse disorder. METHOD: The results are collected on the basis of an extensive literature research in PsychInfo, Science Direct and Medicine. RESULTS: Considering the pros and cons, it can be concluded that smoking cessation should be offered to this subgroup of high risk smokers. The open question is which kind of interventions are effective. Intervention strategies should consist of a multi-level approach including structural as well as person-specific components. Evaluation studies show that a 12% abstinence rate at one year follow-up can be achieved in case of an intensive intervention in combination with a restrictive tobacco policy. Alcohol abstinence is not jeopardised by a concurrent smoking cessation, when smoking cessation is voluntary. CONCLUSIONS: On the basis of empiric research the common arguments against smoking cessation within the subgroup of alcohol-addicted smokers cannot be maintained on the basis of empiric research. Rehabilitation centres treating substance abuse disorders provide an excellent setting for the treatment of nicotine dependence. Interventions should include structural as well as subgroup-specific components.

Alcoholism↗

Combined modality treatment of locally advanced lung cancer.

This paper describes the mechanisms of action of ionizing radiations combined with antineoplastic drugs. Some relevant drugs for the combined modality treatments of locally advanced lung cancer are reported. The meta-analyses including randomized trials comparing single agent (radiotherapy or chemotherapy) versus combined chemotherapy and radiotherapy in patients with unresectable non small cell lung cancer and limited small cell lung cancer are then reviewed. The clinical outcome in relation to different schedules of chemoradiotherapy (sequential, alternating and concurrent) is also focussed.

Chemotherapy, Adjuvant↗

Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy.

OBJECTIVE: To examine short- and long-term mesh-related complications in women undergoing abdominal sacral colpopexy with concurrent hysterectomy, compared with women with a prior hysterectomy undergoing sacral colpopexy alone. METHODS: Patient characteristics, hospital complications, postoperative clinical course, and long-term graft-related complications were reviewed for all women with genital prolapse who underwent abdominal sacral colopexy between 1996 and 1998. Women with concurrent hysterectomy were compared with women with vaginal prolapse after a prior hysterectomy. RESULTS: One hundred twenty-four patients, 60 with concurrent hysterectomy and 64 with prior hysterectomy, were observed postoperatively for a median of 35.5 (0-74) months. Demographics of the two groups were similar, with a mean age of 65.1 +/- 9.4 years and a mean body mass index of 25.8 +/- 4.2 kg/m(2). Eighty percent of colpopexies used prolene synthetic mesh and 20% allograft material. Initial operative and hospital complications were rare in both groups and included a blood transfusion of 2 U, a ureteral transection, a wound infection, heart block, and an arrhythmia. Delayed graft complications included one mesh erosion in a patient with a prior hysterectomy that was managed by office resection (0.8%). CONCLUSION: Concurrent hysterectomy with abdominal sacral colopopexy has a low incidence of mesh complications and can be used as a first-line treatment for genital prolapse.

Aged↗

Papillon-Lefèvre syndrome with albinism: a review of the literature and report of 2 brothers.

BACKGROUND: Papillon-Lefèvre syndrome (PLS) is a very rare autosomal recessive disorder characterized by palmoplantar hyperkeratosis and severe early onset of destructive periodontitis leading to premature loss of both primary and permanent dentitions. The etiopathogenesis of the condition suggests that there is a genetic basis for susceptibility to specific virulent pathogens. Variation in the clinical presentation of PLS has recently been observed. OBJECTIVE: The objective was to present the first report, which describes the concurrence of PLS and albinism. The etiology, pathology, and management of the condition were reviewed and genetic analysis was performed. SUBJECTS AND CLINICAL PRESENTATION: The probands are Jordanian brothers aged 13 and 20 years on their initial presentation. The parents were second cousins and not affected. The patients exhibited the typical clinical features of PLS with type 1 oculocutaneous albinism (OCA1). They also had increased susceptibility to infection manifested in recurrent tonsillitis, respiratory tract infection, pyoderma, onychogryphosis, and other pathosis. Skin biopsy demonstrated hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis. Ectopic calcification of the dura was noticed in one of the probands. Hematological parameters tested were within the normal limits. The probands were tested for mutations in the causative genes of PLS and OCA1, cathepsin C (CTSC), and tyrosinase, respectively. Independent mutations (c.318-1G>A and c.817G>C/p.W272C) were identified in CTSC and tyrosinase, respectively. The probands were homozygous and their sister who had only PLS was homozygous for the same (CTSC) mutation but heterozygous for tyrosinase gene. CONCLUSION: We hope that this report of coinheritance PLS and albinism will initiate further investigations to disclose other possible variations that may enhance our knowledge on gene mutations of this intriguing syndrome.

Adolescent↗

Risk of nephrotoxicity with combination vancomycin-aminoglycoside antibiotic therapy.

One hundred five patients receiving concurrent aminoglycoside and vancomycin therapy of at least 5 days' duration were retrospectively reviewed for development of nephrotoxicity. All had their vancomycin and aminoglycoside serum concentrations controlled by a clinical pharmacokinetics service. Nephrotoxicity occurred in 28 (27%) of the patients. Twenty-two of the 28 had other factors that are known to contribute to renal failure (amphotericin B therapy, sepsis, liver disease, obstructive uropathy, pancreatitis, anesthesia). The remaining six developed nephrotoxicity without other known contributing factors. Logistic regression analysis revealed associations between nephrotoxicity and age, sex, aminoglycoside trough and vancomycin peak and trough serum concentrations, length of aminoglycoside and vancomycin therapy, concurrent amphotericin B therapy, liver disease, neutropenia, and peritonitis (p less than 0.05). In addition to factors previously reported, this study found that neutropenia and peritonitis are associated with an increased risk of nephrotoxicity. Patients with one or more risk factors warrant close monitoring of renal function as well as vancomycin and aminoglycoside serum concentrations.

Aged↗

Antilibidinal drugs and mental retardation: a review.

A minority of people with mental retardation have sexual behaviour which is socially unacceptable or which brings them into conflict with the law. Such behaviour may be the result of ignorance about sexual matters, often best managed by counselling or by a behavioural approach. There are a small number of men with mental retardation and aberrant sexual behaviour who benefit from the prescription of an antilibidinal drug. Treatment with an antilibidinal drug alone reduces the intensity of sexual drive but does not alter its direction; concurrent sexual counselling or psychotherapy is often indicated. The various antilibidinal medications available are reviewed, with particular attention to reports which have described the treatment of people with mental retardation. Of the antilibidinals currently used, medroxyprogesterone acetate and cyproterone acetate are those for which there is most evidence of efficacy. Cyproterone acetate is preferable because it has a specific antiandrogenic action and fewer adverse effects. There is a need for controlled studies of antilibidinal drugs, with clearly defined inclusion criteria and adequate measures of both behavioural and attitudinal change.

Benperidol↗

Proton pump inhibitors and acute interstitial nephritis.

BACKGROUND & AIMS: Proton pump inhibitors (PPIs) are a widely prescribed class of drugs, and their usage worldwide is increasing. Although well-tolerated, there have been case reports and a recent case series implicating these drugs in acute interstitial nephritis (AIN) and progression to acute renal failure (ARF). The aim of this study was to investigate how widespread this complication is in Australia, to identify which PPIs are implicated, and to establish whether PPI-induced AIN is a class effect. METHODS: We undertook a retrospective case review of potential cases at 2 teaching hospitals and a review of registry data from the Therapeutic Goods Administration of Australia (TGA). Parameters sought included the drug implicated, concurrent medications, symptoms, signs, serum creatinine, and time of onset after prescription. RESULTS: We identified 18 cases of biopsy-proven PPI-induced AIN causing ARF in the retrospective case review, which is the largest hospital-based case series to date. The TGA registry data identified an additional 31 cases of "biopsy proven interstitial nephritis." An additional 10 cases of "suspected interstitial nephritis," 20 cases of "unclassified acute renal failure," and 26 cases of "renal impairment" were also identified. All 5 commercially available PPIs were implicated in these cases. CONCLUSION: With the ever more widespread use of this class of medications, PPI-induced AIN is likely to become more frequent. There is now evidence to incriminate all the commercially available PPIs, suggesting there is a class effect. Failure to recognize this entity might have catastrophic long-term consequences including chronic kidney disease. Increased awareness might facilitate more rapid diagnosis and management of this potentially reversible condition.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Sheway's services for substance using pregnant and parenting women: evaluating the outcomes for infants.

Sheway is a single-access comprehensive street-front service to pregnant and parenting women with a history of alcohol and/or drug abuse that is located in one of Canada's poorest neighbourhoods, the Downtown Eastside of Vancouver. This investigation assesses the concurrent health and social problems clients report upon entry into the program, service utilization, and the impact of services on neonate and infant well-being. Data were collected through the review of files from the 9 1/2 years of the agency's service. Findings suggest that the clients' concurrent health and social problems have increased over the years of operation while indicators of infant health have either improved or maintained steady rates.

Alcoholism↗

Long-term assessment of CO2 facial laser resurfacing: aesthetic results and complications.

Several series have documented the ability of the carbon dioxide laser to smooth facial rhytids; however, follow-up has been limited to several months. Since 1995, more than 600 full or partial facial resurfacings were performed with the pulsed CO2 laser. To assess the long-term efficacy and safety of this procedure, the results of 211 resurfacings were retrospectively reviewed using a custom-designed database. Variables that were input included patient demographics, Fitzpatrick skin type, smoking history, prior and concurrent facial procedures, laser pass data, and postoperative complications. Short and long-term aesthetic results were graded by a blinded panel of plastic surgery reviewers (none of whom performed the laser resurfacing) using a standardized photographic rhytid scale. For each facial region, this scale consisted of eight high-resolution photographs depicting increasingly severe wrinkling. Facial rhytids were almost completely ablated at the 3 and 6 month follow-up. Some relapse was seen at 1 year, but the overall aesthetic result remained very good. Regions with dynamic rhytids (e.g., the perioral region) showed more recurrence. The best and most durable results were seen in the cheeks. Infection and scleral show each occurred in 13 patients (6 percent). Forty-five patients (21 percent) developed postprocedure hyperpigmentation, but the overwhelming majority of this group were treated before our postoperative antipigment regimen. Hypopigmentation was noted in 17 patients (8 percent) in this early follow-up group. Two patients (1 percent) developed postoperative scarring. It is hoped that these data will serve to provide additional information on the long-term results of laserbrasion.

Adult↗

Pediatric laparoscopic appendectomy for acute appendicitis.

BACKGROUND: The benefit of laparoscopy in the treatment of pediatric acute appendicitis continues to be controversial, particularly as it relates to operative time and costs. METHODS: We reviewed the charts of 200 children who underwent appendectomy for acute appendicitis concurrently over 35 months at a large teaching children's hospital. RESULTS: Laparoscopic ( n = 105) [corrected] and open ( n = 95) appendectomies were performed. The operative times and postoperative lengths of hospital stay were similar for the two groups. The mean total hospital cost for the laparoscopic group (5,572 dollars) was significantly higher than for the open group (4,472 dollars); ( p < 0.01). CONCLUSIONS: Notably, the results show similar operative times for laparoscopic and open appendectomy. The cost of laparoscopic appendectomy for acute appendicitis is higher than for the open procedure. This study challenges health care providers to reduce costs and develop new ways to measure beneficial outcomes in a pediatric population that may reveal laparoscopic benefits.

Acute Disease↗

The prognostic value of concurrent phrenic nerve palsy in newborn children with Erb's palsy.

The prognostic value of concurrent phrenic nerve palsy in newborn babies with Erb's palsy was investigated. The records of 191 babies with Erb's palsy were reviewed retrospectively at two institutions. Poor spontaneous return of the motor function of the limb was found for infants both with and without concurrent phrenic nerve palsy. Concurrent phrenic nerve palsy in newborn babies with Erb's palsy has no prognostic value in predicting spontaneous motor recovery of the limb.

Arm↗

Medical management of pelvic relaxation.

Although most gynecologists consider surgery to be the treatment of choice for pelvic relaxation, there are many non-surgical forms of therapy for this problem and conditions which it may produce, such as urinary incontinence. This review highlights the importance of properly diagnosing co-existent factors which may complicate a patient's condition, and reviews therapies which may relieve her discomfort without surgery. These options include manipulation of concurrent medical factors, estrogen therapy, pelvic muscle rehabilitation through exercise and electrical stimulation, prompted voiding regimens, and the use of supportive pessaries.

Estrogen Replacement Therapy↗

Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials.

OBJECTIVES: To determine if video assisted thoracic surgery is associated with better clinical outcomes than thoracotomy for three common procedures: surgery for pneumothorax, minor resections, and lobectomy. DESIGN: Systematic review of randomised clinical trials. DATA SOURCES: Medline, Embase, Cochrane database of systematic reviews, Cochrane controlled trials register. Reference lists of relevant articles and reviews. METHODS: Criteria for inclusion were random allocation of patients and no concurrent use of another experimental medication or device. At least two authors performed and confirmed data abstraction and analyses. Information on quality of trials, demographics, frequency of the events, and numbers randomised were collected. RESULTS: 12 trials randomised 670 patients. Video assisted thoracic surgery was associated with shorter length of stay (reduction ranged from 1.0 to 4.2 days) and less pain or use of pain medication than thoracotomy in the five out of seven trials in which the technique was used for pneumothorax or minor lung resection. In the treatment of pneumothorax, video assisted thoracic surgery was associated with substantially fewer recurrences than pleural drainage in two trials (from 20 to 53 events prevented per 100 treated patients). No substantial advantages were observed for video assisted thoracic surgery in lobectomies. CONCLUSIONS: Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections. As for lobectomy, further studies are needed to determine how it compares with thoracotomy.

Drainage↗

Contribution of radiotherapy to function preservation and cancer outcome in primary treatment of nasopharyngeal carcinoma.

Development of primary treatment for nasopharyngeal carcinoma is summarized and the contribution of radiotherapy (RT) is reviewed. Accumulation of knowledge, together with technological advances, has led to significant improvement both for tumor control and organ preservation. With contemporary RT, it is possible to achieve a 10-year disease-specific survival of 47% with a severe late complication rate of 5%. Presenting stage is one of the most important prognostic factors, but unfortunately late presentation and delayed diagnosis remains a common problem. The average local control rate is 80% for tumor confined within the nasopharynx, but only 50% for those associated with erosion of the base of the skull or cranial nerve involvement. Nodal deposits from nasopharyngeal carcinoma are much more radiosensitive than those from other head and neck cancers. An average control rate of 75% can be achieved with RT alone, even in patients with nodes > 6 cm in diameter. Successful locoregional control is important, not only because it is crucial for survival but also because it is associated with a lower incidence of distant failure (29% versus 41%). Distant failure remains a sinister problem, especially for patients presenting with advanced T or N-stage cancers. Randomized trials exploring the value of additional chemotherapy are reviewed. The significant improvement in 3-year overall survival achieved by the addition of concurrent and adjuvant chemotherapy (78% versus 47%) recently reported is encouraging, but remaining uncertainties are also discussed.

Brachytherapy↗

Information processing in the cerebral hemispheres: selective hemispheric activation and capacity limitations.

Several previous experiments have found that concurrently maintaining verbal information in memory influences visual laterality patterns (e.g., Hellige & Cox, 1976; Kinsbourne, 1975). The present article critically reviews existing experiments and reports five additional experiments designed to identify the mechanisms responsible for such effects. Experiment 1 demonstrates that laterality patterns are not influenced by a concurrent memory task that does not require verbal processing. (The verbal nature of the concurrent task was an important aspect of previous experiments.) Experiments 2 and 3 were designed to determined whether concurrent verbal memory primarily influences very early visuospatial processes or later processes such as those involved in visuospatial memory. In Experiment 2, observers indicated whether two simulteneously presented nonsense forms had the same shape. Observers held 0, 2, 4, or 6 words in memory during each shape judgment trial. Responses were faster when the forms were presented to the left visual field--right hemisphere (LVF-RH) than to the right visual field--left hemisphere (RVF-LH). This effect did not interact with memory set size. In Experiment 3, observers indicated whether either of two simultaneously presented forms was identical to a target form held in memory. Observers held 0, 2, or 6 words in memory on each trial. On same-as-target trials, responses were faster on LVF-RH trials than on RVF-LH trials in the no-word memory condition; this difference was reversed in the two-word and six-word conditions. The combined results of Experiments 2 and 3 suggest that concurrent verbal memory influences stages of processing beyond the initial registration of visuospatial information. Experiments 4 and 5 examined the influence of concurrent verbal memory on verbal laterality tasks. Observers indicated whether two simultaneously presented letters of different cases had the same name. In Experiment 4, different groups of observers held 0, 2, 4, or 6 words in memory on each letter-pair trial. In Experiment 5, memory set size was manipulated within subjects. On the same-pair trials of Experiment 4 and the first session of Experiment 5, responses in the no-memory condition were faster on RVF-LH trials than on LVF-RH trials; this difference was reversed in all of the work memory conditions. This shift is opposite to that found when the laterality task does not require verbal processing and further indicates that concurrent verbal memory influences processing stages beyond those that are common to the form-pair and letter-pair tasks. Neither directness-of-pathway nor attention-gradient laterality models can explain the entire pattern of results from the present experiments. Rather, the results suggest that the left hemisphere functions as a typical limited-capacity information processing system that can be influenced somewhat separately from the right hemisphere system.

Cerebral Cortex↗

Diet and low-density lipoprotein particle size.

Small, dense low-density lipoprotein (LDL) particles are being increasingly recognized as an important risk factor for cardiovascular disease. This paper provides an overview of how different diets and macronutrients modulate the LDL size phenotype. Data reviewed indicated that several components of the LDL size phenotype should be measured concurrently in order to fully appreciate the impact of diet on this complex trait. Data also suggested that numerous dietary elements have a significant impact on several characteristics of the LDL size phenotype, thus providing further evidence to the concept that specific dietary modifications can beneficially alter cardiovascular disease risk beyond their known and demonstrated effects on plasma LDL cholesterol concentrations.

Cardiovascular Diseases↗

Gallbladder disease in patients undergoing laparoscopic adjustable gastric banding.

BACKGROUND: Patients undergoing weight loss surgery may have an increased incidence of subsequent gallbladder disease. Management options include treatment of symptomatic disease only, preoperative ultrasonography and concurrent cholecystectomy in presence of stones, routine concurrent cholecystectomy, and choleretic therapy postoperatively. Here we report our approach to patients undergoing laparoscopic adjustable gastric banding (LAGB) and subsequent outcomes. METHODS: A retrospective review of all consecutive patients undergoing LAGB at our institution was performed. Only symptomatic patients were preoperatively evaluated for cholelithiasis and underwent concurrent cholecystectomy. No choleretics were used postoperatively. Weight loss data were collected when patients returned for band adjustments. All band adjustments were patient-driven and performed under fluoroscopic guidance. RESULTS: Between November 2001 and July 2004, 324 patients underwent LAGB. Mean starting weight was 143.6 kg (range, 92.3 to 250.5 kg), and mean body mass index was 50.5 kg/m(2) (range, 35.6 to 80 kg/m(2)). Fifty-six patients had undergone previous cholecystectomy, and 7 other patients underwent concurrent cholecystectomy. Average follow-up was 12.5 months (range, 1.3 to 31 months). Absolute weight loss for all patients ranged from - 2.7 to 102.3 kg. Of the remaining patients, 3 underwent subsequent uneventful laparoscopic cholecystectomy for symptomatic cholelithiasis. No independent predictors for post-LAGB gallbladder disease were identified. CONCLUSION: Despite significant weight loss, few patients require cholecystectomy after LAGB. Routine preoperative ultrasonography, empiric cholecystectomy, and choleretic therapy are of questionable value in LAGB patients. Considering the magnitude of weight loss in our patients, empiric cholecystectomy for all bariatric procedures may merit further investigation.

Adolescent↗