Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study

BACKGROUND: A novel transoral incisionless fundoplication (TIF) procedure using the EsophyX system with SerosaFuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion. The safety and efficacy of TIF for treating gastroesophageal reflux disease (GERD) were evaluated in a prospective multicenter trial. METHODS: Patients (n = 86) with chronic GERD treated with proton pump inhibitors (PPIs) were enrolled. Exclusion criteria included an irreducible hiatal hernia > 2 cm. RESULTS: The TIF procedure (n = 84) reduced all hiatal hernias (n = 49) and constructed valves measuring 4 cm (2-6 cm) and 230 degrees (160 degrees -300 degrees ). Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding. Other adverse events were mild and transient. At 12 months, aggregate (n = 79) and stratified Hill grade I tight (n = 21) results showed 73% and 86% of patients with >or=50% improvement in GERD health-related quality of life (HRQL) scores, 85% discontinuation of daily PPI use, and 81% complete cessation of PPIs; 37% and 48% normalization of esophageal acid exposure; 60% and 89% hiatal hernia reduction; and 62% and 80% esophagitis reduction, respectively. More than 50% of patients with Hill grade I tight valves had a normalized cardia circumference. Resting pressure of the lower esophageal sphincter (LES) was improved significantly (p < 0.001), by 53%. EsophyX-TIF cured GERD in 56% of patients based on their symptom reduction and PPI discontinuation. CONCLUSION: The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms, PPI use, hiatal hernia, and esophagitis, as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients.Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Pegfilgrastim reduces the length of hospitalization and the time to engraftment in multiple myeloma patients treated with melphalan 200 and auto-SCT compared with filgrastim

To reduce the duration of neutropenia after conditioning chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT), granulocyte-colony stimulating factors (G-CSF) are commonly administered. We retrospectively evaluated the impact of pegfilgrastim compared to filgrastim on neutrophil engraftment, hospital stay, and supportive measures in patients with multiple myeloma after conditioning with Melphalan 200 (Mel200) followed by APBSCT. Ninety-two APBSCT after Mel200 treatment were performed in 72 patients between January 2006 and December 2009 at our institution. Patients received either single-dose pegfilgrastim (n = 46; 50%), or daily filgrastim (n = 46; 50%) after APBSCT (median duration of filgrastim use, 9 days; range, 3-14 days). Duration of neutropenia grade IV was shorter with pegfilgrastim compared with filgrastim (median, 5 days (range, 3-14 days) versus 6 days (range, 3-9 days), p = 0.0079). The length of hospitalization differed significantly (pegfilgrastim (median, 14.5 days; range, 11-47 days) versus filgrastim (median, 15.5 days; range, 12-64 days), p = 0.024). Pegfilgrastim-treated patients had less red blood cell transfusions (median, 0 transfusions (range, 0-10) versus 0.5 transfusions (range, 0-9), p = 0.00065). Pegfilgrastim was associated with reduced cost of the treatment procedure compared with filgrastim (p = 0.031). Pegfilgrastim appears to be at least equivalent to filgrastim without additional expenditure in myeloma patients treated with Mel200 and APBSCT

Vasoconstrictive effect of portal blood in isolated dog kidney

Humoral vasoactive substances coming from portal blood have been considered as a possible cause of renal dysfunction in cirrhotic patients. We have thus investigated the effect of perfusion of portal blood from anesthetized dogs on the isolated kidney functions. Both kidneys of a dog were simultaneously perfused on 2 Nizet's pump oxygenators, one kidney serving as control for the other. Renal blood flow was decreased in kidneys perfused with portal blood, as compared to the paired control kidneys perfused with sus-hepatic blood (group A experiments). Addition of polymyxin B to the portal blood restored the renal blood flow to the control level (group B experiments). No significant changes appeared between experimental and control kidneys for glomerular filtration rate, urine output, sodium and water excretion, renin activity, angiotensin II levels, plasmatic PGE2 levels, in group A as well as in group B. We conclude that portal blood of dogs contains vasoactive substances reducing renal blood flow; their action is mediated neither by the renin-angiotensin system nor by changes in renal PGE2 production. The complete abolition of this effect by Polymyxin suggests that these substances may be endotoxins.In VitroJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Restless-Legs-Syndrom

SummaryRestless legs syndrome (RLS) is characterised by an uncontrollable urge to move, in particular the lower limbs, often accompanied by discomfort or a painful sensation that occurs typically at night. It is categorized under the ICD-Classification of extrapyramidal and movement disorders. As patients often suffer from insomnia due to the involuntary nocturnal leg movements and irritable sensations in the legs, RLS is also classified as a sleep-related movement disorder. The incidence of a mild form of RLS is frequent, although it often remains undiagnosed.After the exclusion of other diseases by differential diagnosis, RLS is diagnosed on the basis of a clinical test administering a single dose of levodopa. There are two forms of RLS: idiopathic and secondary. The secondary form is encountered in an astonishing number of diseases, including renal insufficiency, diabetes, chronic obstructive pulmonary disease (COPD) and iron deficiency. The treatment of RLS is complex and the benefits and risks of pharmacotherapy should be considered carefully. Non-ergoline dopamine agonists (e.g. ropinirole, pramipexole) are the first-line treatment in severe cases of RLS. Transdermal rotigotine is also a promising treatment option. Opioids in combination with naloxone are recommended for patients suffering from severe pain. In mild cases of RLS, patients benefit from a balanced lifestyle with gentle physical activity and avoiding the excessive consumption of caffeine or alcohol.</jats:p

Wundschmerz

SummaryIn acute and chronic wounds, pain represents a common and central medical problem. Wound pain can be caused by multiple factors, such as macro- or microvascular as well as inflammatory processes.The basic concept of pain management is based on the WHO pain ladder. Often this concept of pain therapy remains insufficient. Apart from the conventionally used anal-getics, there are not yet established guidelines for the use of alternative substances.Ultimately the adequate wound pain therapy must be adjusted to each patient and his comorbidities.</jats:p

Komplexes regionales Schmerzsyndrom (CRPS)

Einleitung: Das komplexe regionale Schmerzsyndrom (CRPS) ist eine relativ seltene, jedoch für die Betroffenen äußerst gravierende Erkrankung, welche meist distal einer Extremitätenverletzung auftritt. Die klinischen Symptome sowie die Schmerzen stehen in keinem Verhältnis zum auslösenden Ereignis. Bei etwa 10% der Patienten liegt gar kein auslösendes Ereignis vor. Bei ungefähr der Hälfte der Patienten führt CRPS zu dauerhafter Arbeitsunfähigkeit und hohen Behandlungs- und Folgekosten. Klinik: Es werden zwei Formen unterschieden. Beim CRPS 1 lässt sich keine Nervenläsion nachweisen, wohingegen es beim CRPS 2 zu einer Verletzung eines Nerven oder Nervenhauptstamms gekommen ist. Im klinischen Verlauf gibt es jedoch keinen Unterschied zwischen den beiden Formen. In ca. 90 % aller Fälle handelt es sich um ein CRPS 1, früher als „Morbus Sudeck“ bekannt. Das Leitsymptom sind Schmerzen. Zudem können auch trophische Störungen wie Schwelllungen, lokale Verfärbungen der Haut oder asymmetrische Hauttemperaturen auftreten. Häufig finden sich auch eine eingeschränkte Beweglichkeit und Funktionseinbuße der betroffenen Extremität, welche sehr schwer zu therapieren sind. Diagnostik: Initial kann die Unterscheidung eines CRPS von einem normalen posttraumatischen Verlauf schwierig sein. Im weiteren Verlauf stehen die gravierenden Symptome in keinem Verhältnis mehr zum auslösenden Ereignis. Die Diagnose eines CRPS wird primär klinisch gestellt. Die Budapest-Kriterien helfen, die Diagnose zu sichern. Therapie: Eine frühe und interdisziplinäre Rehabilitation ist zentral in der Therapie des CRPS. Ergo- und physiotherapeutische Maßnahmen werden ergänzt mit einer guten medikamentösen Schmerzeinstellung sowie gegebenenfalls auch psychologischer Unterstützung. Medikamentös kommt das analgetische Stufenschema der WHO zum Einsatz, bei starken Hyperalgesien zeigte Methadon gute Erfolge, bei therapieresistenten Schmerzen auch Gabapentin oder Pregabalin. Biphosphonate zeigten einen guten analgetischen Effekt, insbesondere bei nachgewiesenen ossären Läsionen. Die chronischen Ödeme und Entzündungen können einen vorübergehenden Einsatz von Steroiden erfordern. Weiter gilt es, Folgeschäden wie Osteoporose zu verhindern. Patienten, bei welchen der Verdacht auf ein CRPS geäußert wird, sollten durch ein multidisziplinäres Behandlungsteam mit möglicher großer Erfahrung in der Betreuung dieses Krankheitsbildes überwiesen werden. Ein Arzt sollte die Betreuung des Patienten koordinieren. Je früher die Behandlung begonnen wird, desto besser ist die Prognose