Abstruse diagnosis of obturator hernia--a case series

The diagnosis of obturator hernia is one of suspicion as it is almost never seen and rarely palpated. The incidence is less than 1% of all hernias worldwide. Five cases of obturator hernias are reported where the diagnosis of obturator hernia were overlooked. Keywords: obstruction, obturator hernia, small intestine

The effect of substitution of Mn by Fe and Cr on the martensitic transition in the Ni50Mn34In16 alloy

The potential shape memory alloy Ni(50)Mn(34)In(16) is studied with partial substitution of Mn with Fe and Cr to investigate the effect of such substitution on the martensitic transition in the Ni-Mn-In alloy system. The results of ac susceptibility, magnetization and electrical resistivity measurements show that while the substitution with Cr increases the martensitic transition temperature, the substitution with Fe decreases it. Possible reasons for this shift in martensitic transition are discussed. Evidence of kinetic arrest of the austenite to martensite phase transition in the Fe substituted alloys is also presented. Unlike the kinetic arrest of the austenite to martensite phase transition in the parent Ni(50)Mn(34)In(16) alloy which takes place in the presence of high external magnetic field, the kinetic arrest of the austenite to martensite phase transition in the Fe doped alloy occurs even in zero magnetic field. The Cr substituted alloys, on the other hand, show no signature of kinetic arrest of this phase transition.

Internal dynamics in SDS micelles: neutron scattering study

The molecular dynamics of sodium dodecyl sulfate (SDS) micelle has been investigated using high-resolution incoherent quasielastic neutron scattering technique. Data analysis clearly shows presence of two distinct motions: whole micellar motion or global diffusion and faster internal motion of the SDS monomer. The global diffusion associated with the whole micelle is found to be Fickian in nature, and the corresponding diffusion coefficients are found to be consistent with those obtained from dynamic light scattering measurements. The internal motion is described with a model consistent with the structure of the micelle and which accounts for the flexibility of the chains. The SDS monomer consists of a head group, which lies on the surface of the globular micelle, and a tail that hangs from the head toward the center of the globule. Considering various factors like conformational changes of the SDS chains, bending, stretching of the chemical bonds, etc., the dynamics of the SDS molecules is successfully described by a model in which the hydrogen atoms undergo localized translational motion confined within spherical volumes. This volume increases linearly along the SDS chain such that the hydrogen atoms closer to the head group move within smaller spheres with lower diffusion constant than the hydrogen atoms away from the head group. This model is found to be consistent with the data over the whole temperature and concentration range. Diffusivity and the volume of the spheres are also found to increase with temperature. The effect of lowering the SDS concentration is found to be similar to that of increasing the temperature.

Abstruse diagnosis of obturator hernia--a case series

The diagnosis of obturator hernia is one of suspicion as it is almost never seen and rarely palpated. The incidence is less than 1% of all hernias worldwide. Five cases of obturator hernias are reported where the diagnosis of obturator hernia were overlooked.

Endoscopic radiofrequency ablation for Barrett's esophagus: 5-year outcomes from a prospective multicenter trial

BACKGROUND AND STUDY AIMS

The AIM-II Trial included patients with nondysplastic Barrett's esophagus (NDBE) treated with radiofrequency ablation (RFA). Complete eradication of NDBE (complete response-intestinal metaplasia [CR-IM]) was achieved in 98.4 % of patients at 2.5 years. We report the proportion of patients demonstrating CR-IM at 5-year follow-up.

PATIENTS AND METHODS

Prospective, multicenter US trial (NCT00489268). After endoscopic RFA of NDBE up to 6 cm, patients with CR-IM at 2.5 years were eligible for longer-term follow-up. At 5 years, we obtained four-quadrant biopsies from every 1 cm of the original extent of Barrett's esophagus. All specimens were reviewed by one expert gastrointestinal pathologist, followed by focal RFA and repeat biopsy if NDBE was identified. Primary outcomes were (i) proportion of patients demonstrating CR-IM at 5-year biopsy, and (ii) proportion of patients demonstrating CR-IM at 5-year biopsy or after the single-session focal RFA.

RESULTS

Of 60 eligible patients, 50 consented to participate. Of 1473 esophageal specimens obtained at 5 years 85 % contained lamina propria or deeper tissue (per patient, mean 30 , standard deviation [SD] 13). CR-IM was demonstrated in 92 % (46 / 50) of patients, while 8 % (4 / 50) had focal NDBE; focal RFA converted all these to CR-IM. There were no buried glands, dysplasia, strictures, or serious adverse events. Kaplan-Meier CR-IM survival analysis showed probability of maintaining CR-IM for at least 4 years after first durable CR-IM was 0.91 (95 % confidence interval [CI] 0.77 - 0.97) and mean duration of CR-IM was 4.22 years (standard error [SE] 0.12).

CONCLUSIONS

In patients with NDBE treated with RFA, CR-IM was demonstrated in the majority of patients (92 %) at 5-year follow-up, biopsy depth was adequate to detect recurrence, and all failures (4 / 4, 100 %) were converted to CR-IM with single-session focal RFA.

Contamination of ground water as a consequence of land disposal of dye waste mixed sewage effluents: a case study of Panipat district of Haryana, India

Spatial samples of surface and ground water collected from land disposal site of dye waste mixed sewage effluents at Binjhole, in Haryana, India were analyzed to evaluate its effect on quality of pond, hand pumps and ground waters for human health and irrigation purposes. It was found that average COD and TDS of dye houses discharge (310 and 3,920 mg/L) and treated sewage (428 and 1,470 mg/L) on mixing acquired the values of 245 and 1,780 mg/L and only Pb (0.24 microg/L) was above the permissible limit for irrigation purpose. Disposal of this mixed water to village pond changes the COD and TDS to 428 and 1,470 mg/L, respectively. COD and TDS of hand pump water samples were 264 and 1,190 mg/L, where as in tube well water these values were 151 and 900 mg/L. Though the ground water contamination seemed to decrease with the increasing distance from the pond but COD, TDS and BOD values continued to be quite high in water samples drawn from the hand pumps up to a distance of 500 m from pond. However, the major cause of the concern in these waters was Pb (0.11-0.45 ppm). Crops grown with this water shows accumulation of heavy metals like Pb,Cd, Fe, Mn, Ni, Cu, and Zn but in few crops they (Zn, Pb and Cd) exceed the safe limits. Regular consumption of these crop products may lead heavy metal toxicity. It was concluded from this study that the deep seepage of effluents led to deterioration of ground water quality for drinking purposes and the well waters rendered unfit for irrigation purposes within a span of 2 years. This warrants appropriate disposal measures for sewage and dye industry effluents in order to prevent deterioration of ground water and health of human and animals.

Postvaricella purpura fulminans with no evidence of disseminated intravascular coagulation (DIC) or protein S deficiency

The mechanism of postvaricella purpura fulminans is thought to be due to development of antiprotein S antibodies. These antibodies lead to an acquired transient severe protein S deficiency which results in disseminated intravascular coagulation and microvascular thrombosis. Here a patient presented with postvaricella purpura fulminans, where no clinical or laboratory evidence of disseminated intravascular coagulation could be found and there was no deficiency of protein S.

Dynamics of Propylene adsorbed in Na-Y and Na-ZSM5 Zeolites: A QENS and MD Simulation Study

Here we report dynamics of propylene (smallest asymmetric hydrocarbon) adsorbed in two different host systems – Na-Y and Na-ZSM5 zeolites as studied by quasielastic neutron scattering (QENS) techniques and molecular dynamics (MD) simulation techniques. MD simulation studies suggested that the rotational motion of propylene is much faster than the translation. Therefore, two different spectrometers were used to determine the translational and rotational contributions. Analysis of the QENS data (ΔE~200 μeV) revealed that the translational motion of propylene in Na-ZSM5 zeolite is a factor of 3 slower than that in Na-Y zeolite. This is consistent with the smaller void volume available in Na-ZSM5 zeolite as also the fact that the adsorption of propylene is stronger in Na-ZSM5 as compared to that in Na-Y zeolite as indicated in the Fourier Transformed Infra Red (FTIR) studies. This result is further corroborated by the MD simulation studies. It was found that the translation motion occurs at three time scales in both the systems, only one of which corresponds to that observed through the QENS measurements. To probe the faster rotational motion experiments were carried out on a Triple axis spectrometer with wider energy window (ΔE~3meV). The variation of the elastic incoherent structure factor (EISF) suggests that the observed QE broadening corresponds to isotropic rotational motion of propylene in both the hosts. Rotational diffusion coefficients of propylene molecules are found to be of the same order in both zeolites. Trajectories obtained from MD simulation corresponding to the rotational motion revealed that although on a large time scale, the rotation appears isotropic, but at short time scales the channel structure of the Na-ZSM5 restrict the rotation of propylene molecules. This is in contrast with propylene adsorbed in Na-Y zeolite where rotation remains isotropic even at short time scale. A comparison with other hydrocarbon-zeolite systems as studied by us is also presented here.

Monomer Dynamics in SDS Micellar Solution

Monomer dynamics in sodium dodecyl sulfate (SDS) micellar solution at room temperature as studied by quasi elastic neutron scattering (QENS) technique is reported. The elastic incoherent structure factor (EISF) obtained from the analysis of QENS data suggests that the SDS chains perform uniaxial rotational diffusion along the long molecular axis. The rotation diffusion coefficient was found to decrease with the increase in the concentration of the surfactants. It is observed that on addition of electrolyte (0.8 M NaCl) the motion is arrested. Addition of salt is known to induce the growth in SDS micelles, here it is found to affect the dynamics of monomers also. This is due to the combined effect of closer packing of the monomers within the micelle and the tendency of amphiphilic molecules to stabilize due to the presence of electrolytes.

Assessment of response to neoadjuvant therapy in esophageal cancer: an updated systematic review of diagnostic accuracy of endoscopic ultrasonography and fluorodeoxyglucose positron emission tomography

For assessing response to neoadjuvant therapy in patients with esophageal cancer, both endoscopic ultrasonography (EUS) and fluorodeoxyglucose positron emission tomography (FDG-PET) are commonly used, and despite few controlled trials, it is not known if one imaging modality is superior to the other. Also, relative diagnostic accuracy of early (during the course of neoadjuvant therapy) and FDG-PET after completion of neoadjuvant therapy has not been reviewed. The aim of this study was to perform a systematic review of published information to compare diagnostic accuracy of EUS and FDG-PET in this setting. A search of the MEDLINE, EMBASE, and Cochrane databases was performed along with a manual search of cross-references of eligible articles. Data on the accuracy of the imaging modalities were compared by constructing summary receiver-operating characteristic curves. Seven studies with EUS and 15 with FDG-PET were included in the final analysis (N= 966). The sensitivity of EUS and FDG-PET ranged from 20 to 100% and 42 to 100%, respectively. The specificity ranged from 36 to 100% and 27 to 100%, respectively. The areas under the curve were 0.86 (95% confidence interval [CI]: 0.77-0.96) for EUS and 0.80 (95% CI: 0.72-0.89) for FDG PET (P= 0.37). The maximum joint sensitivity and specificity (Q* index) values for EUS and FDG-PET were 0.79 (95% CI: 0.70-0.88) and 0.74 (95% CI: 0.66-0.81), respectively (P= 0.38). There was no difference in accuracy between early FDG-PET and FDG-PET after completion of neoadjuvant therapy. EUS and FDG-PET have similar overall diagnostic accuracy for assessment of response to neoadjuvant therapy in patients with esophageal cancer.

A scanning Hall probe imaging study of the field induced martensite-austenite phase transition in Ni50Mn34In16 alloy

The martensite to austenite phase transition in the off-stoichiometric Heusler alloy Ni(50)Mn(34)In(16) can be induced both by temperature change and by application of a magnetic field. We have used scanning Hall probe imaging to study the magnetic field induced martensite-austenite phase transition. The study provides clear visual evidence of the coexistence of the martensite and austenite phases across this field induced transition in both increasing and decreasing magnetic fields. Clear evidence of thermomagnetic history effects associated with the martensite-austenite phase transition is also obtained. Quantitative analysis of the magnetic field dependence of the volume fraction of the austenite phase in Ni(50)Mn(34)In(16) shows evidence of a nucleation and growth mechanism across the field induced martensite-austenite phase transition. The local M-H loops constructed from the Hall images indicate the presence of a landscape of the critical magnetic field (for the field induced transition) distributed over the sample volume and thus confirm the disorder influenced nature of this first-order magnetic phase transition.

Radio-toxicity of spent fuel of the advanced heavy water reactor

The Advanced Heavy Water Reactor (AHWR) is a new power reactor concept being developed at Bhabha Atomic Research Centre, Mumbai. The reactor retains many desirable features of the existing Pressurised Heavy Water Reactor (PHWR), while incorporating new, advanced safety features. The reactor aims to utilise the vast thorium resources available in India. The reactor core will use plutonium as the make-up fuel, while breeding (233)U in situ. On account of this unique combination of fuel materials, the operational characteristics of the fuel as determined by its radioactivity, decay heat and radio-toxicity are being viewed with great interest. Radio-toxicity of the spent fuel is a measure of potential radiological hazard to the members of the public and also important from the ecological point of view. The radio-toxicity of the AHWR fuel is extremely high to start with, being approximately 10(4) times that of the fresh natural U fuel used in a PHWR, and continues to remain relatively high during operation and subsequent cooling. A unique feature of this fuel is the peak observed in its radio-toxicity at approximately 10(5) y of decay cooling. The delayed increase in fuel toxicity has been traced primarily to a build-up of (229)Th, (230)Th and (226)Ra. This phenomenon has been observed earlier for thorium-based fuels and is confirmed for the AHWR fuel. This paper presents radio-toxicity data for AHWR spent fuel up to a period of 10(6) y and the results are compared with the radio-toxicity of PHWR.

Yeast cell-wall products containing beta-glucan plus ascorbic acid affect neonatal Bos taurus calf leukocytes and growth after a transport stressor

The objectives were to ascertain whether a yeast cell-wall derivative that was 1.8% beta-glucan in combination with ascorbyl-2-polyphosphate could improve innate immunity and mediate transportation stress in neonatal calves, and to compare the 1.8% beta-glucan yeast cell-wall derivative with a more purified yeast cell-wall derivative (70% beta-glucan). Treatments were 1) an unsupplemented control (CNT); 2) 113 g of a 1.8% (approximately 2%) beta-glucan derivative of yeast cell walls plus 250 mg of l-ascorbic acid phosphate (BG2); or 3) 150 mg of a purified beta-glucan fraction from yeast cell walls (approximately 70% beta-glucan) plus 250 mg/feeding of l-ascorbic acid phosphate (BG70). Calves (n = 39) were transported for 4 h, placed in outdoor hutches, and randomly assigned to treatments. Treatments (mixed with a milk replacer) were individually fed twice daily for 28 d. Calves were offered calf starter, free choice, throughout the study. Weekly starter intake and BW were measured, and fecal samples were collected for Salmonella Typhimurium and Escherichia coli O157:H7 PCR analysis. Blood was collected immediately before transport (d 0) and on d 3, 7, 10, 14, 21, and 28 after transport. Starter intake and DMI were less (P < 0.05) at d 28 for the BG2 and BG70 treatments compared with the CNT treatment. Hematocrit percentages increased (P = 0.002) throughout the experiment. White blood cell counts (treatment x time interaction, P = 0.066) were less for the calves supplemented with BG70 than for those supplemented with BG2 (P = 0.01) or for CNT calves (P = 0.04) on d 28. Granulocyte counts changed (P = 0.04) throughout the experiment. A trend (P = 0.077) for a treatment x time interaction was detected for peripheral blood mononuclear cell counts (PBMC). Counts of PBMC were greater (P = 0.006) for the BG2 treatment compared with the CNT treatment on d 3. Calves given the BG70 supplement had fewer PBMC than those given the BG2 supplement on d 21 (P = 0.03) and 28 (P = 0.05). Fibrinogen concentrations were affected only by time (P = 0.002). Time effects were detected for phagocytosis (P = 0.005), oxidative burst (P < 0.001), expression of cluster of differentiation 18 (P = 0.001), and increased cluster of differentiation 18 (P = 0.006). Phagocytosis was less (P = 0.05) for calves in the BG70 group than for those in the CNT group. Percentage of calves positive for E. coli O157:H7 was greatest (P <or= 0.05) for those in the BG2 group on d 7 compared with those in the other treatments. The BG2 and BG70 supplements both increased feed intake, but only the BG2 supplement increased E. coli shedding on d 7, and the BG2 and BG70 supplements varied in modulating immune functions, indicating differences in yeast extract function.

Cutaneous Metastases from Carcinoma of Gall Bladder

Abstract

Renal replacement therapy in intensive care unit

Acute renal failure requiring renal replacement therapy (RRT) is a frequent complication in critically ill patients with high morbidity and mortality. Early prediction of who is going to need RRT is clinically useful in the intensive care unit (ICU). Patients' with diuretic resistant pulmonary edema, hyperkalemia/metabolic acidosis refractory to medical therapy and uremic complications (pericarditis, encephalopathy, bleeding) are candidates who need RRT as an earlier intervention with continuous haemofiltration, which might be beneficial to the patient and even prevent clinicians from implementing unnecessary, futile and perhaps injurious escalations in medical therapy (e.g., low-dose dopamine, mannitol boluses, further fluid loading, introduction of additional vasoactive drugs) to rescue kidneys that are beyond rescuing. Recent evidence also suggests that RRT may be useful as an immunomodulator and best initiated early in the course of the patient's illness with multiple system involvement.

Cutaneous metastases from carcinoma of gall bladder

Cutaneous metastases from internal carcinoma are relatively rare. Metastasis to extremities is still rarer. We report a case of cutaneous metastasis from carcinoma of gall bladder in a 40-year female presenting as a mass in the left lower thigh. The mass was there for four months duration which was progressively growing in size and painful. Mass was 5 x 7 cm2 in size, mobile, hard and tender. The skin overlying the swelling was eroded with ulcer formation showing sloping edge and slough in the floor. Fine needle aspiration cytology and excisional biopsy revealed a metastatic adenocarcinoma. Cutaneous metastases have been regarded as a bad prognostic indicator.

Simplified and versatile method for bisulfite-based DNA methylation analysis of small amounts of DNA

Epigenetic alterations of gene function play a central role in the pathogenesis of many tumors and in the process of aging. Abnormal methylation at transcriptional sites of genes results in epigenetic silencing of the genes that protect against tumor formation or that repair DNA. To date, several studies have analyzed methylation status by oligonucleotide arrays, restriction analysis (COBRA), methylation-specific amplification, and sequence analysis. This requires high concentration of bisulfite-treated DNA, which mandates use of commercially available expensive kits, and is an often laborious and time-consuming task. In this article, we report a simplified high-throughput method, which can serve as a surrogate for screening methylation profiles of various genes and has high sensitivity compared with the other methods described previously.

Strain induced ferromagnetism in Sb co-doped ZnMnO samples

We report on the effect of Sb co-doping on the structural and magnetic properties of bulk ZnMnO samples. Samples with nominal compositions Zn(0.98-y)Mn(0.02)Sb(y)O (y = 0, 0.01 and 0.03) were synthesized using a solid state reaction route at 800 °C. X-ray diffraction (XRD) results reveal wurtzite structure of pure ZnO without any impurity phases for compositions y = 0.0 and 0.01. On the other hand, a weak diffraction peak corresponding to the impurity phase Zn/MnSb(2)O(6) was detected in the XRD pattern of composition y = 0.03. Energy dispersive x-ray (EDAX) results confirm the presence of all elements in the samples in the stoichiometric ratio. The M-H curve of the pure ZnMnO sample shows paramagnetic behavior, whereas M-H curves of Sb co-doped samples show room temperature ferromagnetism (RTFM) with saturated loops. Saturation magnetization (M(S)) and coercive field (H(C)) both increase with the increase in Sb doping percentage. Inverse susceptibility (1/χ) versus temperature (T) curves suggests dominant antiferromagnetic interactions in the samples which decrease with the co-doping of Sb. Based on the experimental results we conclude that the observed RTFM in Sb co-doped ZnMnO is due to defects induced by strain.

An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett's esophagus

BACKGROUND AND AIMS

Advances have occurred in the development of safe and effective ablative therapies for Barrett's esophagus. The aim of the current study was to perform an economic analysis evaluating the cost-effectiveness of endoscopic ablation of nondysplastic Barrett's esophagus.

METHODS

A Markov model evaluated three competing strategies in a hypothetical 50-year-old cohort with nondysplastic Barrett's esophagus from a societal perspective. Strategy I -- natural history of Barrett's disease (without surveillance); Strategy II -- surveillance performed according to the American College of Gastroenterology practice guidelines; Strategy III -- endoscopic ablative therapy. The model was biased against ablative therapy with a conservative estimate of complete response and continued standard surveillance even after complete ablation. All potential complications were accounted for, and an incomplete histological response after ablation was presumed to have the same risk of progression as untreated Barrett's. Transitional probabilities, discounted cost, and utility values to estimate quality-adjusted life-years (QALY) were obtained from published information. Direct costs were used in our analysis.

RESULTS

In baseline analysis, the ablative strategy yielded the highest QALY and was more cost-effective than endoscopic surveillance. In a Monte Carlo analysis, the relative risk of developing cancer in the strategy based on endoscopic ablation was decreased compared with the other strategies. In threshold analysis, the critical determinants of cost-effectiveness of the ablative strategy were rate of complete response to ablation, total cost of ablation, and risk of progression to dysplasia.

CONCLUSIONS

Within the limits of the model, ablation for nondysplastic Barrett's esophagus is more cost-effective than endoscopic surveillance. Clinical trials of ablative therapy in nondysplastic Barrett's esophagus are needed to establish its effectiveness in reducing cancer risk.

Newer methods over the conventional diagnostic tests for tuberculous meningitis: do they really help?

Rapid diagnosis of tuberculous meningitis (TBM) is crucial as the disease outcome depends on the stage at which the treatment is initiated. The reliability of the available tests has not been established; thus, the present study was conducted to evaluate the conventional diagnostic tests as compared to the newer methods. Cerebrospinal fluid was collected from 100 children, and analyzed for various biochemical and cytological tests. The samples were subjected to Ziehl-Neelsen (Z-N) staining, Lowenstein-Jensen (L-J) culture, BACTEC culture and polymerase chain reaction (PCR). Twenty-two patients could be identified as definitive TBM based on the demonstration of Mycobacterium tuberculosis by BACTEC culture and PCR. Of these 22 cases, Z-N staining was positive in only two and L-J culture in six cases. Both the BACTEC culture and PCR had 100% agreement in the diagnosis of TBM. However, BACTEC culture could be a better diagnostic test as drug sensitivity can also be performed by this method.

Radiofrequency ablation for total Barrett's eradication: a description of the endoscopic technique, its clinical results and future prospects

Stepwise circumferential and focal radiofrequency ablation using the HALO system is a novel and promising ablative modality for Barrett's esophagus. Primary circumferential ablation is performed using a balloon-based bipolar electrode, while secondary treatment of residual Barrett's epithelium is performed using an endoscope-mounted bipolar electrode on an articulated platform. It has been used as a single-modality treatment or in combination with other therapies. Recent studies suggest that this ablation technique is highly effective in removing Barrett's mucosa and its associated dysplasia without the known drawbacks of photodynamic therapy or argon plasma coagulation, such as esophageal stenosis and subsquamous foci of intestinal metaplasia (also known as "buried Barrett"). [nl]In this review paper we will explain the technical background of radiofrequency ablation using the HALO system, give a summary of its current status, and speculate on possible future applications.

Intralesional immunotherapy with killed Mycobacterium w vaccine for the treatment of ano-genital warts: an open label pilot study

BACKGROUND

Intralesional immunotherapy with skin test antigens and vaccines has been found to be effective in the management of genital and extragenital warts.

OBJECTIVE

To evaluate the efficacy and safety of intralesional Mycobacterium w (Mw) vaccine monotherapy for the treatment of ano-genital warts.

PATIENTS AND METHODS

Ten patients clinically diagnosed to have external ano-genital warts, including three with giant ano-genital warts (Buschke Löwenstein tumour), were included in this open-label pilot study. Two patients were human immunodeficiency virus seropositive, and one was on iatrogenic immunosuppression for renal transplantation. Mw vaccine (0.1 mL) was initially injected intradermally in the deltoid region on both the sides, followed 2 weeks later by intradermal intralesional injection into the genital warts. Intralesional injections were repeated weekly until either complete clearance or a maximum of 10 injections was achieved.

RESULTS

One patient was lost to follow-up after the first intralesional injection. In 8 out of remaining 9 patients (88.9%), the genital warts cleared completely. In one patient with giant perianal wart, the lesion was reduced to less than 5% of its volume after 10 intralesional injections, which was later electrosurgically excised. The treatment was well tolerated by the majority of the patients. The adverse reactions were noted in four patients, which were reversible. No recurrence was seen after a mean follow-up of 5.1 months.

CONCLUSION

Intralesional immunotherapy of ano-genital warts with Mw vaccine seems to be a promising new approach, which needs to be evaluated in the randomized controlled trials.

A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system)

BACKGROUND AND STUDY AIMS

Yearly surveillance endoscopy is carried out for Barrett's esophagus with low-grade dysplasia (LGD) so that progression to high-grade dysplasia and adenocarcinoma can be detected at the earliest stage. The aim of the study was to assess the long-term safety and effectiveness of circumferential ablation followed by focal ablation (HALO system) for eliminating Barrett's esophagus and LGD.

PATIENTS AND METHODS

Patients with 2 - 6 cm of Barrett's esophagus with histology demonstrating LGD on their last two sequential endoscopies over the previous 2 years and confirmed by two pathologists were enrolled in this prospective, single-center trial. Circumferential ablation was carried out at baseline and at 4 months (if residual Barrett's esophagus present). Endoscopy with 4-quadrant biopsies every 1 cm was performed at 1, 3, 6, 12, and 24 months. After 1 year, focal ablation was applied to any visible Barrett's esophagus or irregularity of the squamocolumnar junction. Patients received lansoprazole 30 mg bid. Complete responses for dysplasia (CR-dysplasia) and intestinal metaplasia (CR-IM) at 2-year follow-up, with complete response defined as "all biopsies negative for dysplasia or intestinal metaplasia" were the main outcomes.

RESULTS

Ten patients (nine men, mean age 66.9 years, range 48 - 79) with confirmed LGD (median 4.4 cm, range 3 - 6) underwent circumferential ablation with focal ablation after 1 year as necessary. At 2 years, CR-dysplasia was 100 % and CR-IM was 90 %. There were no strictures or buried intestinal metaplasia at follow-up.

CONCLUSION

A stepwise regimen of circumferential ablation followed by focal ablation appears to eradicate intestinal metaplasia (90 % CR-IM) and dysplasia (100 % CR-dysplasia) at 2-year follow-up in this trial, without stricture formation or buried intestinal metaplasia.