[Predictors of osteopenic syndrome in idiopathic pulmonary fibrosis]

AIM

To evaluate the functional state of bone tissue in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation, and to determine possible predictors of lower bone mineral density (BMD) in this pathology in the pretransplantation period.

SUBJECTS AND METHODS

Forty-nine IPF patients waiting for lung transplantation were examined. The patients' mean age was 53.4 +/- 6.4 years. BMD in the lumbar spine (L(II)-L(IV)) and femoral neck (FN) was estimated using dual-energy X-ray absorptiometry. All the patients underwent external respiratory function test, pulmonary diffusing capacity (DL(CO)), gasometry, and 6-minute walk test (6'WT).

RESULTS

Osteopenia was recorded in 77% of the examinees, of them 28% had osteoporosis (OP). Normal BMD in both L(II)-L(IV) and FN was found only in 13% of the patients. The T score in L(II)-L(IV) was directly related to body mass index. There was a direct correlation between BMD in L(II)-L(IV) and FN, forced vital capacity (FVC), DL(CO), and arterial blood oxygen saturation (SaO2) and an inverse correlation with arterial carbon dioxide partial pressure (pCO2). No significant correlation was found between the distance covered in 6'WT, FEV1, pO2, and BMD in both L(II)-L(IV) and FN. Six (15%) subjects had atraumatic fractures at different sites.

CONCLUSION

Osteopenia is a common systemic manifestation in patients with IPF in the pre-transplantation period. BMI, FVC, exercise desaturation, and DL(CO) may be considered as predictors for the development of OP initiated by IPF.

Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?

BACKGROUND

Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients.

AIM

To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis.

METHODS

We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients.

RESULTS

A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87).

CONCLUSIONS

Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.

Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?

BACKGROUND

Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients.

AIM

To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis.

METHODS

We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients.

RESULTS

A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87).

CONCLUSIONS

Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.

[Association between adipokines and the development of osteopenic syndrome in end-stage lung disease]

AIM

To study of an association between adipokines, nutritional status, and bone mineral density (BMD) in end-stage lung disease (ESLD).

SUBJECTS AND METHODS

Forty-seven patients aged 26 to 62 years with ESLD were examined. BMD in the lumbar spine (L(II)-L(IV)) and left femoral neck (FN) was estimated using dual-energy X-ray absorptiometry (DXA). The serum levels of adipokines (leptin, adiponectin resistin, tumor necrosis factor-alpha (TNF-alpha), and its receptors sTNFR I, II) were determined. A control group consisted of 45 healthy volunteers matched for age and gender.

RESULTS

Osteopenic syndrome (T-score < -1 SD) was recorded in 43 (91%) of the 47 examined patients with ESLD. In lung diseases, the concentrations of adiponectin, resistin, TNF-alpha, and its receptors were higher and the level of leptin was lower than in the control group. There was a positive correlation between the content of leptin (r = 0.64, p = 0.0002; r = 0.52, p = 0.009) and a negative correlation between adiponectin (r = -0.54, p = 0.009; r = -0.47, p = 0.003), TNF-alpha (r = -0.43, p = 0.03; r = -0.41, p = 0.04), and BMD in FN and FN L(II)-L(IV). Correlation analysis showed a positive correlation between the level of resistin (r = 0.57; p = 0.004), sTNFR I (r = 0.42; p = 0.03), sTNFR II (r = 0.44; p = 0.04), and BMD in L(II)-L(IV) only. The serum leptin level was positively correlated with body mass index (BMI) (r = 0.82; p < 0.0001) and total fat mass (TFM) (r = 0.84; p < 0.0001). On the contrary, the level of adiponectin was inversely correlated with BMI (r = -0.68; p < 0.001), serum resistin concentration (r = -0.57; p = 0.004), sTNFR I (r = -0.58; p = 0.007), and sTNFR II (r = -0.53; p = 0.006). It was stated that there was a strong inverse correction between the levels of leptin and adiponectin (r = -0.67; p = 0.0008).

CONCLUSION

The found associations between adipokines and BMD may suggest that these markers are implicated in the pathogenesis of osteopenic syndrome in ESLD.

[Intracardiac hemodynamics in patients with isolated chronic obstructive pulmonary disease and coronary heart disease]

Analysis of intracardiac hemodynamics is presented in patients with isolated stage II, III and IV chronic obstructive pulmonary disease (COPD) in the period of exacerbation and in those having COPD with concomitant coronary heart disease (stable angina of functional class II). Retrospective evaluation included 100 medical histories. Color Doppler echoCG was performed and parameters of systolic and diastolic function of both ventricles measured. Results of correlation analysis of systolic and diastolic function of left and right ventricles are presented along with the data on blood pressure in the right chambers of the heart.

Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update

This review summarizes the methodological aspects of the interpretation of non-invasive biomarkers in liver fibrosis. A scoring system has been updated to better compare the quality of fibrosis biomarkers. Several methodological issues are related to the classical methodology using biopsy, as this is considered the gold standard. However, from evidence-based data, it appears that the methodology needs to change to prevent flawed conclusions among key opinion leaders as well as in obsolete guidelines. As waiting for the perfect biomarker for the diagnosis of advanced fibrosis to come along is probably a waste of time, in the meantime, methods can be improved. The main proposals for improving the methodology are, to take into account the spectrum bias, to assess accuracy between adjacent stages, to compare biomarkers in the same patient, to assess the cause of failure among discordant cases and to use specific statistical methods adapted for imperfect gold standards.

Continuous infusion of high-dose omeprazole is more effective than standard-dose omeprazole in patients with high-risk peptic ulcer bleeding: a retrospective study

High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown.

AIM

To compare the benefits of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding.

METHODS

We reviewed the medical files of patients admitted between 1997 and 2004 for high-risk peptic ulcer bleeding who had undergone successful endoscopic treatment. We distinguished 2 periods: before 2001, standard-dose omeprazole (40 mg/day intravenously until alimentation was possible, then 40 mg/day orally for 1 week); after 2001, high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week). During both periods, patients subsequently received omeprazole, 20 mg/day, orally for 3 weeks.

RESULTS

We enrolled 114 patients (period 1, n = 45, period 2, n = 69). Therapy with high-dose omeprazole significantly decreased the occurrence of poor outcome (27 vs. 12%, P = 0.04), rebleeding (24 vs. 7%, P = 0.01), mortality due to haemorrhagic shock (11 vs. 0%, P < 0.001) and need for surgery (9 vs. 1%, P = 0.05).

CONCLUSIONS

In this retrospective study, high-dose omeprazole reduced the occurrence of rebleeding, need for surgery and mortality due to hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole.

Doctoring by go-between: aspects of health care for Malay children

The paper is a preliminary account of the way Malay adults handle sickness episodes when they occur among their children. We first show how children are conceived of as different from adults, then give some of the reasons for their vulnerability: their 'vital principle' is weak and unstable, they react more violently to humoral variations, they are related to and attracted by the supernatural world. The second section gives a sample of common indigenous illness categories as applied to children, then summarizes a typical aetiological model including factors that are children-specific. Such factors often point to either parent as initiating the episode by disrupting the animal, symbolic or social world, or by placing the child out of harmony with the outside world. The third section provides an account of therapeutic alternatives, some of which are coherent with the aetiology, others--aiming at restoring the whole person's balance--are not specific of a particular sickness. Both types can be provided by native curers, whereas only the former is expected from urban based general practitioners; we show how Malay parents in fact partly relate to medical doctors as if they were traditional healers. To sum up, we emphasize the mediating role of adults towards sick children: not only do they provide identification and treatment but they often hold themselves responsible for the disorder. We also show the socializing, hence integrating, function of sickness for children: they are gradually taught about the world order, and introduced to the value system of the culture in which they are growing up. We also note that both aetiologies and therapies can be children-specific.(ABSTRACT TRUNCATED AT 250 WORDS)