Missing gastric cancer in dyspepsia

BACKGROUND

Dyspepsia is common in gastric cancer, but also in many benign conditions. European Helicobacter pylori Study Group and American Gastroenterological Association guidelines recommend endoscopy in dyspepsia for patients with alarm symptoms or at age >45 years. However, recommendations are controversial.

AIM

To investigate whether criteria for endoscopy in patients with dyspepsia are adequate to detect gastric cancer.

METHODS

In 215 patients at initial diagnosis of gastric adenocarcinoma, symptoms were classified as alarm and non-alarm. Cases were staged according to the TNM system. Stages T(1)-T(3)N(x)M(0) were defined as potentially curable.

RESULTS

Dyspepsia was present in 128 patients. Among patients with dyspepsia, 15 were < or =45 years and 41 denied alarm symptoms. The combination of both criteria excluded only three (2.3%) patients from endoscopy, but increasing the threshold to >50 and >55 years would have raised the rate of excluded patients to seven (5.5%) and 11 (8.6%). Only 53 potentially curable stages and 18 early gastric cancers occurred, but the tumour stage was not associated with dyspepsia duration, age threshold of 45 years, or alarm symptoms.

CONCLUSIONS

Our results support current European Helicobacter Study Group and American Gastroenterological Association criteria for endoscopy in patients with dyspepsia to detect gastric cancer. Regardless, most cancers are advanced at detection.

Immunogenity of the pneumococcal polysaccharide vaccine in COPD patients. The effect of systemic steroids

RATIONALE

To investigate if systemic steroids influence the antibody response to the 23-valent pneumococcal polysaccaride vaccine (23-PPV) in COPD patients.

PATIENTS AND METHODS

COPD patients on: (a) > or =10mg of prednisolone/day (SS, n = 30); (b) inhalative steroids (IS, n= 30); (c) controls without COPD (CG, n= 29) were vaccinated with 23-PPV. The concentration (microg/ml) of capsular specific anti-pneumococcal IgG antibodies (AB) for the serotypes (PNC) 4,6B,9V,14,18C,19F,23F were measured by Elisa technique before, 3 and 12 months (m) after vaccination. Non-responders were defined when AB-concentrations did neither doubled nor reach > or = 1 microg/ml.

RESULTS

N=24 (CG), n=29 (IS), n= 18 (SS) patients completed the study (mean age 64yrs.). Serious adverse events were not observed. Geometric mean (GM) AB-concentration of all serotypes increased significantly (CG, IS, SS) 3 and 12m after vaccination (P<0.05). The percentage of non-responders ranged between 16% (PNC 19F, IS) and 65% (PNC 4, SS) after 3 m and 21% (PNC 19F, IS) and 82% (PNC 4, CG) after 12m. Neither post-vaccine AB-concentrations (3 and 12m) nor the rate of non-responders differed significantly between patients on systemic steroids and the other groups (IS, CG).

CONCLUSIONS

Systemic steroids did not influence the AB-response. In all groups mean AB-concentration increased significantly after vaccination but an important percentage of subjects of all three groups were non-responders.

Porphyrin metabolism in lymphocytes of miners exposed to diesel exhaust at oil shale mine

The present study was carried out on the evaluation and application of new biomarkers for populations exposed to occupational diesel exhaust at oil shale mines. Since not only genotoxic effects may play an important role in the generation of tumors, the level of porphyrin metabolism was proposed as a biomarker of diesel exhaust exposure effects. The data on determination of 5-aminolevulinic acid (ALA) synthesis and heme formation in lymphocytes from groups of 50 miners exposed to diesel exhaust and 50 unexposed surface workers of oil shale mine are presented. All workers were examined and interviewed using structured questionnaires. The levels of benzene, carbon monoxide and nitric oxides in air as well as concentrations of 1-nitropyrene and elemental carbon in particulate matter were used for evaluation of exposure to diesel exhaust in mine. The levels of ALA and protoporphyrin (PP), activities of ALA synthetase (ALA-S) and ferrochelatase (FC), as well as levels of PP associated with DNA (PP/DNA) were investigated in lymphocytes spectrophotometrically. Significant differences in activity of ALA synthesis and heme formation between exposed miners and surface workers were found (207+/-23 vs. 166+/-14 pmol/10(6) lymp./30' for ALA-S and 46.1+/-3.8 vs. 54.8+/-4.1 pmol/10(6) lymp./60' for FC activities, respectively, P<0.001). ALA-S activity was higher and ALA accumulated in lymphocytes of exposed miners. Inhibition of FC activity caused PP cellular accumulation and an increase in the PP/DNA level (P<0.05). Tobacco smoking led to the increase of ALA biosynthesis in lymphocytes of both surface and underground smokers. The comparison of data obtained for non-smokers and smokers of both groups of workers has shown a significant difference (P<0.05). The work duration of underground or surface workers did not significantly influence the investigated biochemical parameters. The determination of ALA synthesis in lymphocytes could be a useful biomonitoring index of organism sensitivity to underground working. The alterations of PP levels, FC activity and PP/DNA association in peripheral lymphocytes of miners illustrate the harmful effects of exposure to diesel exhaust.

A profile of an HIV-and child-specific programme in New Orleans, Louisiana, USA

Since the beginning of the AIDS epidemic, 4.3 million children under 15 years of age have been infected with HIV worldwide; in the year 2000 alone, the World Health Organization estimates that 600,000 children became HIV-infected. Ancillary services offer the potential to improve access to and retention in primary care through removal of barriers to care. Globally, ancillary services may actually represent a significant proportion of all care delivered to HIV-infected children, particularly in the absence of expensive antiretroviral treatments. The purpose of this non-concurrent cohort study was to describe a population of HIV-infected children receiving ancillary services from an HIV- and family-specific ancillary service programme in New Orleans, Louisiana, USA. Forty-two HIV-infected children ages newborn to 13 years were included in the study. The majority were between one and five years of age (50.0%), male (54.8%), African-American (88.1%), and perinatally infected (97.6%). Services were well utilized; delivery decreased with age and increased with severity of clinical disease. Improved retention, prescription of antiretroviral treatment and HIV-related emergency room utilization were associated with ancillary service receipt. Ancillary services delivered by an HIV- and family-specific programme assist HIV-infected children to receive improved medical care. Ancillary services are a valuable adjunct to primary care, particularly in the complex care of the HIV-infected children from historically underserved populations.

Neurochemical findings in the MPTP model of Parkinson's disease

Animal models are a very important approach to study the pathogenesis and therapeutic intervention strategies of human diseases. Since many human disorders do not arise spontaneously in animals, characteristic functional changes have to be mimicked by neurotoxic agents. For instance, the application of the dopaminergic neurotoxin MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) is able to produce striking similarities to Parkinson's disease (PD) diagnosed in humans. MPTP is thought to selectively damage dopaminergic neurons predominantly those originating in the substantia nigra pars compacta (SNc) which leads to impaired dopaminergic neurotransmission accompanied by a loss of dopaminergic nerve terminals in the striatum. MPTP-induced neurochemical, behavioral, and histopathological alterations replicate very closely the clinical symptoms of PD patients, which will be discussed in this paper and render the MPTP model currently the most favored PD model to study therapeutic intervention strategies in an easy and reliable way in preclinical studies. We and many other research groups propose that the knowledge about the neurotoxic mechanisms of MPTP such as mitochondrial dysfunction with breakdown of energy metabolism and free radical production will help us to understand the underlying mechanisms of PD, which are not fully understood yet. In particular, the novel aspects of inflammatory processes and the involvement of reactive nitrogen species in addition to reactive oxygen species seem to be important milestones for a better understanding of the neurodegenerative effects of MPTP. In this review we focus on the MPTP mouse model which is easy practicable and widely used in neuroscience research and draw comparisons to the human pathology in PD.

Endoscopic diagnosis of a right hepatic artery pseudoaneurysm

Hepatic artery aneurysms are rare occurrences with diverse etiologies. We present a case of a right hepatic artery aneurysm, which was diagnosed at endoscopic retrograde cholangiography (ERC) and treated angiographically. This is the first report where ERC has been critical in delineating the aneurysmal cavity, suggesting the diagnosis and prompting emergency intervention.

An atypical neuropsychological profile of a Korsakoff syndrome patient throughout the follow-up

The basis of amnesia in alcoholic Wernicke-Korsakoff syndrome (WKS) has been generally associated with diencephalic lesions and more specifically with lesions of the anterior thalamic nuclei. These brain structures are considered to be involved in encoding/consolidation processes of episodic memory. However, frontal lobe damage responsible for executive function deficits has also been documented. The present report details the nature and extent of amnesia in an alcoholic patients with WKS and which appears to be mainly due to frontal lobe (executive) deficits.

Low hepatic lipase activity is a novel risk factor for coronary artery disease

BACKGROUND

The crucial function of hepatic lipase (HL) in lipid metabolism has been well established, but the relationship between HL activity and coronary artery disease (CAD) is disputed.

METHODS AND RESULTS

We measured HL activity in the postheparin plasma of 200 consecutive men undergoing elective coronary angiography and determined the degree of CAD with the extent score, which has been shown to be better correlated with known risk factors than other measures of CAD extent. We found a significant inverse correlation between HL activity and the extent of CAD (r=-0.19, P<0.01). This association was mainly due to patients with HDL levels >0.96 mmol/L (n=94, r=-0.30, P<0.005). HL activity was lower in 173 patients with CAD than in 40 controls with normal angiograms (286+/-106 versus 338+/-108 nmol. mL(-1). min(-1), P<0.01). To correct for potential confounding factors, we performed multivariate analyses that confirmed the independent association of HL activity with CAD extent. In addition, the presence of the T allele at position -514 in the HL promoter, which leads to a reduced HL promoter activity, was associated with lower HL activity (r=0.30, P<0.001) and higher CAD extent (42.2+/-20.8 versus 35.3+/-23.6 [extent score], P<0.05). In patients with heterozygous familial hypercholesterolemia, calcified lesions in ECG-gated spiral computed tomography were higher in patients with low HL activity (6.3+/-6.8 versus 1.5+/-3.1, P=0.01).

CONCLUSIONS

Our data show that low HL activity is associated with CAD. Therefore, HL might be useful for CAD risk estimation and might be a target for pharmacological intervention.

Supervisory attentional system in nonamnesic alcoholic men

BACKGROUND

Many studies have shown that recently detoxified alcoholic persons perform poorly on tasks thought to be sensitive to frontal lobe damage, supporting the hypothesis that the frontal lobes are highly vulnerable to chronic alcohol consumption. However, it appeared that most of the executive tasks used in these studies also involved nonexecutive components, and these tasks had been shown to be impaired as a result of nonfrontal lobe lesions. In this study, we examined further the "frontal lobe vulnerability" hypothesis using executive tasks, proved to be associated with frontal lobe functioning, that allowed us to distinguish the relative importance of executive and nonexecutive processes.

METHOD

Thirty recently detoxified asymptomatic male alcoholic inpatients and 30 control subjects were tested for planning, inhibition, rule detection, and coordination of dual task, as well as the speed of processing and nonexecutive functions (such as short-term memory storage).

RESULTS

Alcoholics performed worse than controls in almost all tasks assessing executive functions. However, they were not slower than the controls and showed normal results for nonexecutive functions.

CONCLUSIONS

Chronic alcohol consumption seems to be associated with severe executive function deficits, which are still present after a protracted period of alcohol abstinence. These data support the idea that the cognitive deficits in recently detoxified sober alcoholic subjects are due, at least partly, to frontal lobe dysfunctioning.

Dopamine mediates striatal malonate toxicity via dopamine transporter-dependent generation of reactive oxygen species and D2 but not D1 receptor activation

Intrastriatal injection of the reversible succinate dehydrogenase inhibitor malonate results in both chemically induced hypoxia and striatal lesions that are similar to those seen in Huntington's disease and cerebral ischaemia. The mechanisms leading to neuronal death involve secondary excitotoxicity, the release of dopamine from nigrostriatal fibres and the generation of reactive oxygen species (ROS) including nitric oxide (NO) and hydroxyl radicals. Here, we further investigated the contribution and mechanism of dopamine on malonate-induced striatal lesions. Prior lesions of the nigrostriatal pathway with 6-OHDA or the depletion of striatal dopamine stores by pretreatment with reserpine, an inhibitor or the vesicular monoamine transporter type-2 (VMAT2), in combination with alpha-methyl-p-tyrosine resulted in a significant reduction of malonate-induced striatal lesion volumes. This was paralleled by block or reduction of the malonate-induced generation of ROS, as measured by the conversions of salicylate to 2,3-dihydroxybenzoic acid (2,3-DHBA) using microdialysis. Systemic or intrastriatal application of L-DOPA or dopamine, respectively, reconstituted malonate toxicity and the generation of ROS in 6-OHDA-lesioned rats. Block of the dopamine transporter by GBR12909 did not result in a reduction of malonate-induced dopamine release, but significantly reduced the generation of hydroxyl radicals. The D2 receptor agonist lisuride and the mixed D1 and D2 receptor agonist apomorphine, but not the D1 receptor agonist SKF38393, partially restored malonate toxicity in 6-OHDA-lesioned rats without increasing the generation of ROS. In line with these results sulpiride, an inhibitor of D2 receptors, reduced the malonate-induced lesion volume, whereas SCH23390, an inhbitor of D1 receptors, was ineffective. Our data suggest that malonate-induced dopamine toxicity to energetically impaired neurons is mediated by two independent pathways: (i) dopamine transporter uptake-dependent, dopamine receptor-independent generation of ROS, and (ii) excessive stimulation of D2 receptors.

Neuroprotective effects of (+/-)-kavain in the MPTP mouse model of Parkinson's disease

This is the first study to investigate the potential protective effects of the lipophilic kavapyrone (+/-)-kavain in the experimental MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) model of Parkinson's disease (PD). Male C57BL/6 mice were treated with (+/-)-kavain (50, 100, or 200 mg/kg i.p.) or vehicle 60 min before and 60 min after a single administration of MPTP (30 mg/kg s.c.) or saline, respectively. Mice were sacrificed after 7 days and the neostriatum was analyzed for dopamine and its metabolites using HPLC with electrochemical detection. Furthermore, nigral sections were processed for tyrosine hydroxylase (TH) immunocytochemistry. To determine the effects of (+/-)-kavain (200 mg/kg) on MPTP metabolism, HPLC analysis of striatal MPP(+) (1-methyl-4-phenylpyridinium) levels was performed. MPTP treatment alone led to a significant depletion of striatal dopamine levels to 12.61% of saline controls. The lower dosages of (+/-)-kavain (50 and 100 mg/kg) showed only a nonsignificant attenuation of MPTP-induced dopamine depletion, but a high dosage of (+/-)-kavain (200 mg/kg) significantly antagonized the dopamine depletion to 58.93% of saline control values. Remarkably, the MPTP-induced decrease of TH-immunoreactivity as well as the loss of nigral neurons was completely prevented by (+/-)-kavain (200 mg/kg). Striatal MPP(+) levels were not altered by (+/-)-kavain treatment. In conclusion, we found that MPTP metabolism was not influenced by (+/-)-kavain and postulate the antiglutamatergic effects of (+/-)-kavain for its protective effects against MPTP toxicity. (+/-)-Kavain may be a novel candidate for further preclinical studies in animal models of PD and other disorders with glutamatergic overactivity.

Association between ancillary services and clinical and behavioral outcomes among HIV-infected women

The purpose of this study was to evaluate the association between ancillary services, including case management, and clinical and behavioral outcomes for human immunodeficiency virus (HIV)-infected women. Data were obtained from databases systematically maintained by Family Advocacy, Care and Education Services (FACES) and the HIV Outpatient Program (HOP) in New Orleans. HIV-infected women receiving primary care from HOP and ancillary services from FACES between January 1, 1997 and December 31, 1998 were eligible. Data were analyzed using generalized estimating equations (GEE) with STATA software. The majority of women included in the study were African American (86.7%), infected heterosexually (78.8%), and had absolute CD4 counts greater than 200 (58.6%). After adjusting for age, time, entry time into HOP, pregnancy, CD4 count, substance abuse status, and social and clinical stressors, receipt of more than four combined case manager contacts or ancillary services per month was significantly associated with being prescribed a protease inhibitor, improved adherence and retention in primary care, and enrolling on a research protocol. Receiving more than one transportation service per month was significantly associated with improved adherence, improved retention, one or more emergency room visits per month, and one or more hospitalizations per month. Receiving more than one contact with case managers per month was associated with improved retention in primary care. Findings suggest that receipt of case management and ancillary services is associated with improvements in multiple outcomes for HIV-infected women. A client-centered approach to providing ancillary services appears to be effective in improving behavioral and utilization characteristics in this population of low-income, high-risk women.

Developmental delay and multiple congenital anomalies in a child with a unique combination of partial monosomy 18 and partial trisomy 16

A male child with multiple congenital anomalies and developmental delay is described. Cytogenetic evaluation showed that the patient was partially monosomic for the short arm of chromosome 18 and partially trisomic for the short arm of chromosome 16: a combination of chromosomal syndromes not previously described.