Reflux oesophagitis : an experimental study in rats

The aim of the surgical therapy of reflux oesophagitis is prevention of reflux, and the treatment of the irreversible complications of reflux such as strictures. Recent developments in the treatment of reflux are concentrated on an earlier diagnosis of reflux and oesophagitis and prevention of complications. The discussion as to the best surgical treatment of reflux, has in the course of years suggested several types of operations: - Thoracic reconstruction of oesophageal hiatus according to Allison ( 1951). - Anterior gastropexy according to Boerema (1955). - Abdominal fundiplication according to Nissen (1959). - Trans-thoracic fundiplication (Mark IV) according to Belsey (1967). - Posterior gastropexy according to Hill (1967). The indications for operative treatment of reflux oesophagitis differ from one centre to another. Generally speaking only patients with reflux, and symptoms and signs of reflux oesophagitis are treated. The results of the surgical techniques mentioned above, vary considerably (De Meester et a!, 1974, Behar, 1979). They give little insight in the pathogenesis of the oesophageal inflammation which can occur in the presence of reflux. In the approach to this problem, one could be satisfied with the development of an effective antireflux operation, but perhaps it is more realistic first to study more in detail the fundamental causes of oesophagi tis. This then may offer arguments leading to a more rational indication and choice of operative treatment

Younger women with symptomatic peripheral arterial disease are at increased risk of depressive symptoms

ObjectivesGender disparities, particularly among young women with cardiovascular disease, are a growing cause for concern. Depression is a prevalent and prognostically important comorbidity in peripheral arterial disease (PAD), but its prevalence has not been described as a function of gender and age. Therefore, we compared depressive symptoms at the time of PAD diagnosis and 6 months later by gender and age in PAD patients.MethodsThe study enrolled 444 newly diagnosed patients with PAD (32% women) from two Dutch vascular outpatient clinics. Patients' depressive symptoms were assessed with the 10-item Center for Epidemiological Studies Depression Scale (CES-D) at baseline and 6 months later (CES-D scores ≥4 indicate significant depressive symptoms). Logistic regression models were constructed to evaluate the relationship among four gender-age groups (women <65 and ≥65 years; men <65 and ≥65 years [reference category]) and baseline and 6-month follow-up depressive symptoms.ResultsInitially, 33% of women <65 years had significant depressive symptoms, and 6 months later, significant depressive symptoms had developed in 19% of the other younger women. These rates were much higher than other gender-age groups (range at baseline, 11%-16%; 6-month incidence, 6%-10%; P ≤ .03). Adjusting for demographics and clinical factors, women <65 years experienced a fourfold greater odds of baseline (odds ratio [OR], 4.3; 95% confidence interval [CI], 2.2-8.7) and follow-up depressive symptoms (OR, 4.1; 95% CI, 2.0-8.4) compared with men ≥65 years, whereas other gender-age groups were not at risk. Additional adjustment for change in the ankle-brachial index did not explain the increased depression risk in younger women (OR, 3.5; 95% CI, 1.2-10.2).ConclusionsSignificant depressive symptoms are more common in younger women with PAD than in other gender-age groups, both at the time of diagnosis and 6 months later. To eradicate gender-based disparities in PAD, depression screening and monitoring in younger women may be an important direction for future research and intervention

Is the Perceived Association between Chlamydia pneumoniae and Vascular Diseases Biased by Methodology?

Inter- and intralaboratory inconsistencies in detection rates of Chlamydia pneumoniae in vascular specimens have been demonstrated. In this study, 66 vascular tissue specimens from 66 patients with vascular disease were tested by three PCR assays: a 16S PCR-based reverse line blot (RLB) assay, a single-step PCR, and a nested PCR. Also, we explored the impacts of different DNA polymerase enzymes on the results based on gel electrophoresis and hybridization. The PCR results by gel electrophoresis in the single-step PCR depended on which DNA polymerase was used. All samples were negative with AmpliTaq Gold DNA polymerase, and 54.5% (36 of 66) were positive with the conventional Taq DNA polymerase. All samples were negative after hybridization with a C. pneumoniae-specific probe. In the nested PCR, all specimens were negative by gel electrophoresis and after hybridization. The RLB assay failed to detect C. pneumoniae in any specimen; however, 20 specimens were Chlamydia sp. positive. The sequence analysis of six of these samples demonstrated Chlamydia-like organisms. RLB detected Chlamydia sp. DNA in water and in the elution buffer after passage of the Qiagen columns (11 of 40). This study identified factors that may influence the detection of C. pneumoniae DNA in vascular tissues and consequently bias the perception of a link between C. pneumoniae and vascular diseases. The following are strongly recommended: to use DNA polymerases that have to be activated, to decontaminate with dUTP-uracil-DNA glycosylase, to hybridize with specific probes, to include sufficient controls, and to use molecular grade water

Late spontaneous hemothorax complicating anterior spinal instrumentation in adolescent idiopathic scoliosis

STUDY DESIGN: Case report. OBJECTIVE: Describes a case report of a 16-year-old woman treated for adolescent idiopathic scoliosis (AIS) by anterior spinal fusion and instrumentation, who developed a spontaneous massive intrathoracic bleeding 10 months after surgery. SUMMARY OF BACKGROUND DATA: Hemothorax (HT) is a known rare postoperative complication of anterior spinal scoliosis surgery. However, spontaneous HT has never been described as a late complication, in relationship to diaphragm movement over the anterior instrumentation material. METHODS: Retrospective case report. RESULTS: A 16-year-old woman with Lenke type I AIS underwent a successful anterior spinal fusion with instrumentation. After surgery, there were no complications, however, she experienced a distressing grating sensation while breathing. Ten months after surgery, the patient developed a spontaneous HT that needed emergency surgery. Erosion of a small artery in the scar tissue around the most caudal screw of the instrumentation proved to be the cause of the late HT. Subsequent dynamic magnetic resonance imaging showed the relationship between the moving diaphragmatic muscles and the most caudal screws of instrumentation material during breathing. Sixteen months after the initial surgery, the anterior instrumentation was removed. CONCLUSION: Late spontaneous HT in patients with anterior fusion and instrumentation for AIS is a rare but life-threatening complication

Genome-wide association study identifies a sequence variant within the DAB2IP gene conferring susceptibility to abdominal aortic aneurysm

We performed a genome-wide association study on 1,292 individuals with abdominal aortic aneurysms (AAAs) and 30,503 controls from Iceland and The Netherlands, with a follow-up of top markers in up to 3,267 individuals with AAAs and 7,451 controls. The A allele of rs7025486 on 9q33 was found to associate with AAA, with an odds ratio (OR) of 1.21 and P = 4.6 x 10(-10). In tests for association with other vascular diseases, we found that rs7025486[A] is associated with early onset myocardial infarction (OR = 1.18, P = 3.1 x 10(-5)), peripheral arterial disease (OR = 1.14, P = 3.9 x 10(-5)) and pulmonary embolism (OR = 1.20, P = 0.00030), but not with intracranial aneurysm or ischemic stroke. No association was observed between rs7025486[A] and common risk factors for arterial and venous diseases-that is, smoking, lipid levels, obesity, type 2 diabetes and hypertension. Rs7025486 is located within DAB2IP, which encodes an inhibitor of cell growth and survival