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

Should Helicobacter pylori be eradicated before starting a long term proton pump inhibitor treatment for reflux oesophagitis ? : Esophagitis : new acquisitions

Helicobacter pylori (HP) a été retrouvé au niveau de l'œsophage, uniquement sur un épithélium de type gastrique dans l'oesophage de Barrett, et presque exclusivement chez des patients porteurs d'une contamination gastrique par HP. L'infection de l'oesophage de Barrett par HP n'a aucune influence sur sa sévérité, ses complications ou son histoire naturelle. La contamination gastrique par HP n'est pas un facteur de risque de reflux gastro-oesophagien et au contraire la présence de HP au niveau gastrique, l'inflammation de la partie fundique et la gastrite atrophique pourraient jouer un rôle protecteur contre l'oesophagite par reflux. L'éradication de HP chez les patients porteurs d'un ulcère duodénal expose ceux-ci à un risque de développement d'oesophagite par reflux. HP influence l'efficacité du traitement antisécrétoire: les inhibiteurs de pompe à protons et la ranitidine procurent une réduction de l'acidité gastrique supérieure chez les sujets contaminés par HP par rapport aux sujets HP négatifs. Au cours d'un traitement par inhibiteur de pompe à protons, on constate un déplacement de HP de l'antre vers le fundus. Les traitements prolongés par inhibiteur de pompe à protons provoquent une gastrite atrophique chez les sujets positifs pour Helicobacter pylori, ce qui constitue un argument majeur en faveur de l'éradication de HP chez les patients soumis à une inhibition sécrétoire acide de longue durée

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

Influence of a P53 Mutation on the Radiation Sensitivity of Mouse Zygotes

The aim of studies under way in our laboratory is to investigate whether heterozygous mutations in genes involved in such important cellular processes as cell cycle regulation, apoptosis and DNA repair may influence the radiation sensitivity of early mammalian embryos. The embryonic stage chosen for our first investigations is the zygote (first day of gestation). This stage occurs while women cannot be aware of pregnancy. Moreover, in contradiction with a long standing dogma of teratology, various kinds of malformations were previously found in mouse fetuses from particular (wild-type) strains after X-irradiation at the zygote stage. Our studies mainly concentrate on external congenital anomalies, cytokine secretion in the amniotic fluid and chromosomal instability. Measuring cytokines in the amniotic will enable us to determine whether developmental abnormalities are accompanied by changes in the levels of particular cytokines, as suggested by the few available data. On the other hand, chromosome instability has been recently reported in mouse fetuses from different strains, after x-irradiation at the zygote stage. The gene currently under study is P53, the "genome guardian". The P53 mutation was introduced in the CF1 strain, whose wild-type zygotes had been previously shown by us to be sensitive to radiation induction of congenital anomalies (Jacquet et al., Mutation Res., 332, 73-87, 1995). P53 (+/+ x -/-) or P53 (+/+ x +/-) matings were performed from 7.30 till 9.30 am and the females showing a vaginal plug were x-irradiated with either 0.2 or 0.4 Gy 2 h after presumed fertilization. A number of them were sacrificed on day 8 of gestation, their gastrula stage embryos were collected and their embryonic parts were cultured for 7 h in the presence of colchicine. The cells were then fixed and cytogenetically analyzed. Other females were sacrificed on day 19 of gestation. Pre- and post-implantation losses were recorded, amniotic fluid surrounding the fetuses was collected for cytokine analysis and the living fetuses were weighed and examined under the stereomicroscope for the presence of congenital anomalies. When needed (+/+ x +/- matings), the tails of the fetuses were collected for genotype analysis. So far, and although our results have still to be completed, the P53 mutation did not seem to result into the development of a chromosomal instability and/or to higher levels of congenital anomalies in irradiated embryos. (Partially funded by the research contract n° CO-90 06 2024.00 between SCKCEN and the Federal Agency for Nuclear Control)

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