T helper 2 inflammatory markers are associated with recurrence in chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery

BACKGROUND

Despite maximum medical treatment and endoscopic sinus surgery (ESS), chronic rhinosinusitis with nasal polyps (CRSwNP) can require revision surgery. With a growing literature on the diversity of cytokine inflammation patterns in CRSwNP, an endotype-driven approach could lead to the identification of cytokine profiles that predict recurrence.

METHODS

A monocentric longitudinal study was carried out until June 2019 following CRSwNP patients who underwent surgery for the first time between December 2010 and January 2012. The biomarker profiles were established on blood and nasal secretions at the time of the first surgery (Interleukin (IL)-5, IgE, IgA, eosinophilic cationic protein (ECP) and eosinophilic- derived neurotoxin (EDN)). Profiles were compared between the patients still controlled by medical treatment and the patients requiring revision surgery during the course of the follow-up period.

RESULTS

Among the 48 patients initially enrolled in our study, 8 required revision surgery (16,7%). Clinical features (asthma, allergy, aspirin intolerance, active smoking) and levels of blood markers measured at the time of the first surgery were comparable between the 2 groups of patients. Levels of IL-5, IgE and ECP in nasal secretions were significantly increased in the group of patients needing revision surgery.

CONCLUSIONS

Based on simple approach of nasal secretions sampling, we showed that a predominant T helper 2 proteins expression profile can be associated with recurrent CRSwNP after ESS. Initial immunoprofiling in CRSwNP disease may contribute to better predict the therapeutic response to optimal medical and surgical treatment, and help define the role of innovative targeted treatment, beside corticosteroids and ESS.

Oxidized Low-Density Lipoprotein Induces WNT5A Signaling Activation in THP-1 Derived Macrophages and a Human Aortic Vascular Smooth Muscle Cell Line

The pathogenesis of atherosclerosis is complex, evolves, and involves many cell types. Macrophages and vascular smooth muscle cells (VSMCs) are critically involved in atherosclerosis development and progression. Several studies have shown that WNT5A protein is abundantly expressed in human atherosclerotic lesions; however, the mechanism and role of WNT signaling pathway activation is not clearly known. Using THP-1 derived macrophages, and human aortic VSMC cells, we evaluated in vitro how oxidized low-density lipoprotein (oxLDL) and WNT5A signaling interact in these two cell lines. We used western blot, scratch assay, metabolic proliferation assay, as well as immunostaining to analyze the effect of Wnt signaling activation. The results demonstrated that oxLDL, as well as WNT5A (control), induced Disheveled-2 (DVL2) activation and Kif26b degradation, indicating activation of non-canonical Wnt signaling. We found that oxLDL and WNT5A induced FZD5-ROR2 co-localization at the cellular membrane in vitro in THP-1 derived macrophages. Box5 (FZD5 receptor antagonist) inhibited oxLDL-induced DVL2/JNK activation secondary to newly secreted WNT protein from THP-1 derived macrophages. We found that WNT3A (canonical Wnt) and WNT5A showed different roles in this VSMC cell line. These findings indicate that WNT5A is upregulated by oxLDL, promotes foam cell formation, and affects VSMC phenotype and migration in these two cell lines. Also, in these cell lines FZD5 signaling seems to be necessary for lipid accumulation and, through this mechanism, WNT5A could modulate foam cell formation. Thus, our results suggest that WNT5A may contribute to the pathogenesis of vascular disease through modulating macrophage and VSMC behavior.

Tamponade during immune checkpoint inhibitors therapy in lung cancer: case-reports and systematic review of the literature

Introduction

Immune therapy is a new option that has revolutionized cancer therapy. Immune checkpoint inhibitors target mostly either PD-1 (Pembrolizumab, Nivolumab) or PD-L1 (Durvalumab). Immune-related cardiotoxic side effects, among them, tamponade, initially thought to be rare, seem to be increasingly cited in the literature. Moreover, tobacco smoking is linked to 80% of lung cancers. Smoking during cancer therapy may influence on radiotherapy and chemotherapy outcomes but little is known on immunotherapy.

Purpose

We aimed to review all the published cases of tamponade during immune therapy for lung cancer and to report all the cases that occurred in the University Hospital Ambroise Paré. We also wanted to highlight the possible impact of tobacco on immunotherapy.

Methods

We conducted a literature review in the PubMED database, from database inception up to 02/14/2020, with a combination of the following terms: “tamponade AND ((immune checkpoint inhibitors) OR (PD-1) OR (PD-L1))”. We also reported all the tamponade cases occurred in our hospital from the beginning of immune checkpoint inhibitors therapy existence up to 02/14/2020.

Results

Seventeen cases citing tamponade were identified in the literature to which we added 3 cases from our hospital. Mortality rate at 1 month was of 20%. Nivolumab was involved in 80%, Pembrolizumab in 10% and Durvalumab in 10%. In 75%, lung cancer was with a stage IV. Men accounted for 85% and mean age was of 62 years. Active smokers represented 85% and passive smokers existed in 5%, after diagnosis, smoking cessation was done in 10%. Tamponade occurred either shortly after the first administrations but also after several doses. Pericardial fluid cytology revealed malignant cells in half of the cases and microbiology was always negative. For all the cases, excepted for one who was directly considered as palliative, an evacuation of the pericardial fluid was done. In 45% a corticotherapy was initiated. Two cases quickly worsened after pericardial evacuation by unmasking a probable myocarditis with cardiogenic shock which needed the use of a veno-arterial extracorporeal membrane oxygenation.

Conclusions

Tamponade under immune checkpoint inhibitors therapy appears less rare than initially thought and mortality rate at one month was not negligible. The use of regular echocardiography during this immune therapy may be crucial in detecting early stages of the disease process and smoking cessation should also be advised for these patients. The prevalence of complications among all the patients both exposed to immune therapy and tobacco could not be calculated in this work (case-reports), but some recent studies may indicate survival gains of smoking cessation. Further research establishing more specific guidelines is naturally necessary in dealing with this potentially fatal effect but also in establishing the possibly additional role of smoking in the cardiotoxicity of immunotherapy.

Funding Acknowledgement

Type of funding source: None

P1494Usefulness of longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy

Background

In hypertrophic cardiomyopathy (HCM), longitudinal strain analysis allows to early detect left ventricular (LV) contraction abnormalities despite preserved LV ejection fraction. In current software, the width of the region of interest (ROI) is the same over the entire myocardial wall, and might analyze partially LV hypertrophic segments.

Purpose

The aim of this study is to evaluate a novel software for strain analysis with an adjustable ROI according to each segment thickness.

Methods

We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). All patients underwent echocardiography using a Vivid 9 GE system and measurements were performed using EchoPAC software. Global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for 2 groups) and with software adjusted to the myocardial wall thickness (for HCM group).

Results

GLS was significantly decreased in the HCM group as compared to the control group (−15.1±4.8% versus −20.5±4.3%, p<0.0001). In HCM group, GLS (standard method versus adjusted to thickness) were not significantly different (p=0.34). Interestingly, regional strain adjusted to thickness was significantly lower than standard strain in hypertrophic segments, especially in basal inferoseptal segment (p=0.0002), median inferoseptal segment (p<0.001) and median anteroseptal segment (p=0.02). Strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7±3%, versus −5.9±4.4%, p=0.049 in the basal inferoseptal segment and −5.7±3.5% versus −8.3±4.5%, p=0.0007 in the median inferoseptal segment). Analysis of strain adjusted to thickness had a better feasibility (97.5% versus 99%, p=0.01).

Conclusion

Analysis of longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.

P4653A natural history of carcinoid heart disease in the modern management era

Background

The development of carcinoid heart disease (CaHD) is still relatively unknown at present. It is difficult to define an optimal follow-up for patients initially free from cardiac involvement. The aim of this study was to assess the prevalence and the evolution of CaHD using annual echocardiographic follow-up.

Methods

We reviewed from our database 137 patients (61±12 years, 53% men) with histologically proven neuroendocrine tumor between 1997 and 2017. All patients underwent serial conventional transthoracic echocardiographic studies. Right-sided and left-sided CaHD were systematically assessed. We used a previous validated echocardiographic scoring system of severity for the assessment of CHD. An increase of 25% of the score was considered as significant.

Results

Mean follow-up was 2.6±3.5 years [0; 16]. Prevalence of CaHD was 27% (37 pts) at baseline and 36% (49 pts) at the end of follow-up. Among patients with initial CaHD followed for more than one year, disease progression was observed in 28% of cases. Among the patients free from initial cardiac involvement, an onset of the disease was observed during follow-up in 21% of cases. The onset of CHD could be very late, more than 5 years from the initial echocardiographic examination in 42% of our cases (Figure). This late occurrence of CaHD was only observed in patients presenting with new resumption of neuroendocrine tumor (symptoms, increased of 5-HIAA, occurrence of new metastasis).

Conclusion

Our study demonstrated that in patients without initial CaHD, cardiac involvement may occur tardily after a normal initial assessment. Our data suggest the need for prolonged echocardiographic follow-up in patients presenting with a resumption of tumor process.

Blocking Wnt5a signaling decreases CD36 expression and foam cell formation in atherosclerosis

BACKGROUND AND AIMS

Wnt5a is a highly studied member of the Wnt family and recently has been implicated in the pathogenesis of atherosclerosis, but its precise role is unknown. Foam cell development is a critical process to atherosclerotic plaque formation. In the present study, we investigated the role of noncanonical Wnt5a signaling in the development of foam cells.

METHODS

Human carotid atherosclerotic tissue and THP-1-derived macrophages were used to investigate the contribution of Wnt5a signaling in the formation of foam cells. Immunohistochemistry was used to evaluate protein expression of scavenger receptors and noncanonical Wnt5a receptors [frizzled 5 (Fz5) and receptor tyrosine kinase-like orphan receptor 2 (Ror2)] in human atherosclerotic macrophages/foam cells. Changes in protein expression in response to Wnt5a stimulation/inhibition were determined by Western blot, and lipid accumulation was evaluated by fluorescent lipid droplet staining.

RESULTS

Wnt5a (P<.05), Fz5 (P<.01), and Ror2 (P<.01) were significantly expressed in advanced atherosclerotic lesions compared to less advanced lesions (N=10). Wnt5a, Fz5, and Ror2 were expressed in macrophages/foam cells within the plaque. In vitro studies revealed that Wnt5a significantly increased the expression of the lipid uptake receptor CD36 (P<.05) but not the lipid efflux receptor ATP-binding cassette transporter (P>.05). rWnt5a also significantly increased lipid accumulation in THP-1 macrophages (P<.05). Furthermore, inhibition of Wnt5a signaling with Box5 prevented lipid accumulation (P<.01) and prevented CD36 up-regulation (P<.01).

CONCLUSIONS

These results suggest a direct role for Wnt5a signaling in the pathogenesis of atherosclerosis, specifically the accumulation of lipid in macrophages and the formation of foam cells.

Two cases of distal ulna giant cell tumors treated by extensive resection, prosthetic reconstruction and stabilization using the brachioradialis tendon

Aggressive giant cell tumors are rare at the distal ulna. We report the results of two patients who were treated surgically using a distal ulna prosthesis stabilized by ligament reconstruction with the brachioradialis tendon. At the maximum follow-up of 18months, the two patients were satisfied. Joint range of motion and functional scores were improved. X-rays showed no recurrence or subluxation; however gradual impingement of the ulnar notch of radius by the prosthesis was visible. Our technique seems to be a viable alternative when compared with the treatments described in other published case reports.

Additionality and permanence standards in California's Forest Offset Protocol: A review of project and program level implications

A key component of California's cap-and-trade program is the use of carbon offsets as compliance instruments for reducing statewide GHG emissions. Under this program, offsets are tradable credits representing real, verifiable, quantifiable, enforceable, permanent, and additional reductions or removals of GHG emissions. This paper focuses on the permanence and additionality standards for offset credits as defined and operationalized in California's Compliance Offset Protocol for U.S. Forest Projects. Drawing on a review of the protocol, interviews, current offset projects, and existing literature, we discuss how additionality and permanence standards relate to project participation and overall program effectiveness. Specifically, we provide an overview of offset credits as compliance instruments in California's cap-and-trade program, the timeline for a forest offset project, and the factors shaping participation in offset projects. We then discuss the implications of permanence and additionality at both the project and program levels. Largely consistent with previous work, we find that stringent standards for permanent and additional project activities can present barriers to participation, but also, that there may be a trade-off between project quality and quantity (i.e. levels of participation) when considering overall program effectiveness. We summarize what this implies for California's forest offset program and provide suggestions for improvements in light of potential program diffusion and policy learning.

Results and limitations of humeral head resurfacing: 105 cases at a mean follow-up of 5 years

BACKGROUND

The objective of this study was to assess clinical and computed-tomography (CT) outcomes at least 2 years after humeral head resurfacing to treat concentric gleno-humeral osteoarthritis.

HYPOTHESIS

Humeral head resurfacing provides similar outcomes to those achieved with stemmed humeral head implants.

MATERIALS AND METHODS

This single-centre retrospective study included 40 Copeland™ and 65 Aequalis™ humeral resurfacing heads implanted between 2004 and 2012. Mean patient age at diagnosis was 64 years. The diagnoses were osteoarthritis with an intact (68%) or torn (21%) rotator cuff, avascular necrosis (5%), osteoarthritis complicating chronic instability (3%), post-traumatic osteoarthritis (2%), and chronic inflammatory joint disease (1%). Validated clinical scores, radiographs, and CT before surgery and at last follow-up were compared.

RESULTS

During the mean follow-up of 56 months, complications occurred in 24 implants. Revision surgery with reverse shoulder replacement was required in 18 cases, after a mean of 43.6 months, to treat glenoid wear or a rotator cuff tear. At last follow-up, for the implants that did not require revision surgery, the mean Constant score was 64/100. The implants had a mean varus of 5° and mean retroversion of -13.3°. The mean increase in glenoid cavity depth was 2.4mm. Mean increases in medial and lateral humeral offset were 1.9mm and 2.7mm, respectively. Pre-operative factors significantly associated with failure were rotator cuff tear (P=0.017) and glenoid erosion (P=0.001).

DISCUSSION

We found a high failure rate related to glenoid wear or progressive rotator-cuff impairment, although CT showed no evidence of implant malposition or overstuffing. Previous studies of stemmed humeral head implants showed better outcomes. Given the low medium-term prosthesis survival rate, we now reserve humeral head resurfacing for concentric osteoarthritis without glenoid erosions or rotator cuff damage.

LEVEL OF EVIDENCE

IV, retrospective study.

Chondrosarcoma of the femur in Mazabraud's syndrome: A first case study

Malignant transformation of fibrous dysplasia (FD) in long bones is rare (less than 1% of cases) and occurs in the form of osteosarcomas. They can occur on FD associated with multiple myxomas, which corresponds to Mazabraud syndrome. To our knowledge, only six cases of FD malignant transformation into osteosarcoma in the context of Mazabraud syndrome have been described. Here, we describe the first case of malignant transformation of femur FD into chondrosarcoma in a 51-year-old female patient. The patient had significant changes in the size and number of myxomas around the femur before the malignant transformation into chondrosarcoma. She underwent complete femur replacement with a favourable result after 4 years' follow-up. Close surveillance is strongly recommended in this syndrome, particularly when the number and size of myxomas increase.

Percutaneous CT-guided radiofrequency thermocoagulation in the treatment of osteoid osteoma: a 87 patient series

INTRODUCTION

Osteoid osteoma is a painful, benign bone tumor that mainly affects young people. Thermocoagulation is one of the recommended percutaneous treatment methods. This study sought to assess its efficacy and identify risk factors for osteoma recurrence.

METHODS

Results were analyzed retrospectively for a group of 87 patients treated by thermocoagulation between 2002 and 2011. The recurrence rate was calculated and analyzed relative to patient and tumor characteristics. The treatment efficacy was determined and methods to prevent complications were analyzed.

RESULTS

The mean follow-up time was 34 months. The average patient age was 23 years. There were seven complications including three patients with delayed wound healing, mainly at tibial sites. The recurrence rate was 10.4%. The success rate for first-line treatment was 89.6% and it was 97.5% for second-line treatment. Analysis of patient characteristics and tumor locations revealed no risk factors for recurrence.

CONCLUSION

Percutaneous thermocoagulation is a reliable and effective technique that provides fast, long-lasting pain relief. However recurrence can occur even after the nidus is completely resected. These recurrences can be effectively managed by repeat treatment. Recent technical improvements have reduced the risk of thermocoagulation-related complications.

LEVEL OF EVIDENCE

IV.

Anatomic and CT scan assessment of Teres Minor: a new index of trophicity

INTRODUCTION

The present study reports the development of a CT assessment protocol for Teres Minor (TM) trophicity.

HYPOTHESIS

Quantitative reproductible Terres Minor assessment on CT estimates the influence of muscle trophicity on the clinical and radiological results of palliative treatment of irreparable rotator cuff tear.

MATERIALS AND METHOD

An anatomic study of 30 cadaveric shoulders confirmed a constant anatomic relation between Terres Minor and the inferior pole of the glenoid cavity. This landmark was used to develop a novel CT assessment of TM trophicity.

RESULTS

The CT assessment showed excellent inter- and intra-observer reproductibility. The protocol defines a trophicity index, T2/G (T2 being TM thickness on axial CT slice, and G the maximum glenoid cavity thickness on axial slice), enabling reproductible TM analysis on preoperative arthro-CT.

CONCLUSION

The study validated the CT protocol, allowing application in pre- and postoperative assessment of irreparable rotator cuff tear.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Reproducibility and reliability of subscapularis tendon assessment using CT-arthrography

BACKGROUND

Computed tomography (CT) coupled with arthrography remains the reference standard for the preoperative evaluation of rotator cuff tears. The objectives of this study were to evaluate intra-observer and inter-observer reproducibilities of CT-arthrographic assessment of the subscapularis tendon and to assess the validity and reliability of this investigation.

HYPOTHESIS

CT-arthrography is reliable and reproducible for the preoperative characterisation of subscapularis tendon lesions.

MATERIAL AND METHODS

We retrospectively reviewed 67 shoulders with rotator cuff tears in one or more tendons managed by arthroscopy, both to confirm the diagnosis and to allow therapeutic interventions. Each of the 67 preoperative CT-arthrograms was evaluated by three readers, of whom the first two evaluated the images twice at an interval of 30 days. The following were recorded at each reading: partial- or full-thickness tear in one or more rotator cuff tendons, intra-tendinous delamination, tendon stump retraction, and fatty degeneration of the muscles. The position of the long head of biceps tendon was assessed. A statistical analysis was performed using Fleiss' method to compute intra-observer and inter-observer variabilities in CT-arthrography assessment of the subscapularis tendon status. Validity of this assessment was measured by computing the concordance coefficients between CT-arthrography and arthroscopy.

RESULTS

Specificity of CT-arthrography was satisfactory for assessing the subscapularis tendon. Sensitivity was low. Significant inter-observer and intra-observer variabilities were documented. The concordance coefficients between CT-arthrography and arthroscopy indicated that major differences were common with all three readers. When assessing the subscapularis tendon by CT-arthrography, all readers experienced difficulties in distinguishing intact tendons, delaminated tendons, and tendons with tears confined to the upper third.

DISCUSSION

Although CT-arthrography remains the reference standard for the preoperative investigation of rotator cuff tears, significant variability occurs in assessing the continuity of the subscapularis tendon. Reliability of this assessment is not optimal, as shown by our evaluation of concordance with arthroscopy. Although our data should be interpreted in the light of the investigation and measurement biases present in our study, they suggest that CT-arthrography may fail to provide a valid and reproducible assessment of the subscapularis tendon. The development of magnetic resonance (MR) imaging and MR-arthrography will probably improve the preoperative evaluation of subscapularis tears in the near future.

LEVEL OF EVIDENCE

Level III; diagnostic value study.

Geometrical analysis results of 42 resurfacing shoulder prostheses: A CT scan study

BACKGROUND

Shoulder resurfacing arthroplasty was introduced in Scandinavia in the early 1980s then developed by SA Copeland.

HYPOTHESIS

Resurfacing prostheses restore the normal anatomy of the proximal humerus. Here, our objective was to evaluate humeral resurfacing prosthesis position on radiographs and computed tomography (CT) images.

MATERIALS AND METHODS

We retrospectively reviewed 42 consecutive cases seen at a single centre between 2004 and 2009. Mean patient age was 65 years. CT was performed routinely before prosthesis implantation and at re-evaluation. The Copeland Mark III(®) (Biomet France SARL, 26903 Valence, France) implant was used in 32 cases and the Aequalis Resurfacing Head(®) (Tornier France, 38334 Saint-Ismier, France) in 10 cases. The post-implantation CT images were used to measure the angle of inclination, medial humeral offset, lateral glenohumeral offset, and version of the implant.

RESULTS

Mean follow-up was 18 months. Compared to baseline, no significant changes were found at re-evaluation for the angle of inclination or lateral glenohumeral offset. In contrast, medial humeral offset increased by 3.47mm, and excessive anteversion of 4.23° compared to the bicondylar line was noted.

DISCUSSION

Humeral head resurfacing prostheses restore the overall anatomy of the proximal humeral head. Our CT scan evaluation protocol seems reproducible and enables an evaluation of implant geometry. In our experience, resurfacing arthroplasty restored the native humeral offset. Inadequate retroversion was noted and was probably related to insufficient exposure during surgery.

LEVEL OF EVIDENCE

Level IV, retrospective study.

Sandwich type ceramic liner fracture rate with the Atlas III™ socket: A study of 144 primary total hip replacements at a mean 74 months' follow-up

INTRODUCTION

Ceramic friction bearings have been proposed as a means of reducing wear in total hip replacement (THR). A "sandwich" composite concept including a ceramic bearing surface has been proposed as simplifying the modularity while matching metal-back cups with a polyethylene liner. It is not precisely known how frequently abnormal noise would occur during functioning of this type of implant, which moreover entails a risk of ceramic liner fracture.

HYPOTHESIS

Results with sandwich type ceramic liners are comparable to those with polyethylene liners, without risk of side effects (noise, fracture).

PATIENTS AND METHODS

Clinical and radiological results of 144 cementless Atlas III™ cups containing a 28mm-diameter polyethylene-ceramic sandwich type liner coupled to a ceramic Biolox Forte™ head were retrospectively analyzed at a mean 74 months' follow-up. Mean patient age was 59.4 years. Twelve patients were lost to follow-up. Femoral components comprised 61 ESOP™ anatomic stems and 71 BHS™ Corail stems. The radiologic study used Imagika™ software.

RESULTS

Global function scores were satisfactory: PMA score, 17.2±1.2 (range, 9 to 18); global Harris score, 93.6±3.1 (49 to 100). Global survivorship was 91.6% (95% CI: 86.34-96.9). Radioclinical analysis found seven liner fractures (5.3%) at a mean 32 months; all were non-traumatic and asymptomatic. Clinical risk factors for liner fracture were overweight, advanced age, dislocation, prosthetic impingement, increased postoperative offset was a radiologic risk factor.

DISCUSSION AND CONCLUSION

Despite these satisfactory radioclinical results, matching those for metal-backed implants containing a polyethylene liner, close surveillance is mandatory with this type of composite implant. The high fracture rate with ceramic-polyethylene sandwich type liners and relative lack of symptoms warrant caution in their use.

LEVEL OF EVIDENCE

Level IV, retrospective or historic series.

[Ventricular tachycardia revealed by a left ventricular non-compaction]

We report a case of a 55-year-old woman who has a non-compaction of the left ventricular myocardium diagnosed after a cardiac arrest due to a polymorphic ventricular tachycardia. The patient was implanted with a cardioverter-defibrillator. A review of literature of this recently described cardiopathy is done.

Pantoprazole suppresses Helicobacter pylori without affecting cure

BACKGROUND

Short-term, low-dose triple regimens composed of proton-pump inhibitors (PPI) and two antibiotics are the current gold standard therapy for cure of Helicobacter pylori infection. To date, the effect of PPI pretreatment on eradication outcome is not known. The aim of this study was to evaluate the influence of pretreatment with pantoprazole on the efficacy of an ensuing triple therapy.

METHODS

In this open, randomized, monocenter, parallel group comparison, 107 patients with duodenal ulcer or functional dyspepsia were assigned to receive one of the following treatment regimens: a 7-day triple therapy with pantoprazole, 40 mg bid; clarithromycin, 250 mg bid; and metronidazole, 400 mg bid, which was either preceded or followed by a 7-day therapy with pantoprazole, 40 mg (P-PCM or PCM-P). Assessment of H. pylori status was performed by a biopsy urease test and 13C urea breath test at the initial visit and 13C urea breath test at all follow-up visits.

RESULTS

The 7-day pantoprazole pretreatment resulted in a significant decline of the delta values of the 13C urea breath test. H. pylori infection was cured in 47 of 52 intention-to-treat patients of the P-PCM group (90%; 95% confidence interval, 79-97%) and in 46 of 53 of the PCM-P group (87%; 95% confidence interval, 75-95%).

CONCLUSIONS

Pretreatment with pantoprazole suppresses H. pylori but does not impair the efficacy of a consecutive short-term, low-dose triple therapy.

[13C-mixed triglyceride CO2 exhalation test. Investigation with an isotope selective, non dispersive infrared spectrophotometer of indirect function of the exocrine pancreas]

BACKGROUND AND OBJECTIVE

The 13C-mixed-triglyceride CO2-exhalation test (MTE) has been proposed for the noninvasive assessment of intraluminal duodenal pancreatic lipase activity. Up to now, stable isotope analysis of carbon dioxide of the MTE has been carried out with isotope ratio mass-spectrometry. The aim of the present study was to evaluate the MTE in patients with morphological signs of chronic pancreatitis (stages I-III) and exocrine pancreatic insufficiency by using an isotope-selective nondispersive infrared spectrometer (NDIRS).

PATIENTS AND METHODS

20 healthy volunteers (9 females, 11 males, age range 19-61 years) and 16 patients (7 females, 9 males, age range 33-76 years) were examined. After an overnight fast each patient received a solid-liquid test meal containing 250 mg 1,3 distearyl, 2[13C] octanoyl glycerol. Breath samples were obtained at baseline and at 30 min intervals over a period of 6 h after the test meal. The 13C/12C isotope ratio in each breath sample was determined by NDIRS as delta (%) and delta over baseline (%). Results were expressed as cumulative percentage dose of 13C recovered (cPDR) at 3, 4, 5, 6 h and maximal PDR (PDRpeak) (median; 5./95. percentile).

RESULTS

Significant lower values concerning cPDR 3, 4, 5, 6 hours and PDRpeak [%] were found between healthy subjects and patients with chronic pancreatitis (p < 0.05): cPDR 6 h: 8.1 (0.4-20.5)% vs 29.1 (10.3-59.3)%; PDRpeak: 4.7 (0.4-10.2)% vs 9.2 (5.4-14.3)%.

INTERPRETATION

In general, the MTE discriminates between healthy controls and patients with chronic pancreatitis and exocrine pancreatic insufficiency. However, the MTE using NDIRS cannot be recommended as a method of clinical routine because of marked data overlap between pathologic and normal values.

[The 13C-methacetin breath test for quantitative noninvasive liver function analysis with an isotope-specific nondispersive infrared spectrometer in liver cirrhosis]

BACKGROUND AND OBJECTIVE

Cytochrome-P450-dependent liver function can be measured with the 13C-methacetin breath test (MBT). This has heretofore been done with the use of a mass-spectrometer. This study was undertaken to evaluate the MBT (NDIRS) done with the isotope-selective nondispersive infrared spectrometer.

PATIENTS AND METHODS

20 healthy volunteers (ten women, ten men, aged 22-76 years) and 16 patients (ten women, six men, aged 48-71 years) with histologically confirmed liver cirrhosis (Child-Pugh stage A [n = 7], B [n = 5] or C [n = 4]) were given 13C-methacetin in 100 ml of tea after a 12-hour fasting period. Breath tests were performed before the test drink and 5, 10, 15, 20, 30, 40, 50, 60, 80, 100, 120, 150 and 180 min thereafter. The ratio of 13C to 12C was determined, as delta (/1000), and from it the maximal percentage rate (PDRmax) calculated, as well as the cumulative rate (cPDRmax) after 30, 60, 120 and 180 min (Median and 5th and 95th percentiles).

RESULTS

For patients with liver cirrhosis there were significantly lower values for cPDRmax and cPDR after 30, 60, 120 and 180 min than in the healthy subjects (P < 0.002): PDR [%]/h: 3.9 (0.7-15.9) vs. 36.5 (23.1-50.0); cDPR 30 min [%]: 1.1 (-0.2-6.0) vs. 12.4 (7.6-17.1); cDPR 3 h [%]: 9.8 (-2.3-27.5) vs. 36.0 (29.9-45.1). There were significant differences among the patients, depending on their Child-Pugh staging.

CONCLUSION

The MBT with the cost-effective NDIRS can reliably and noninvasively distinguish between healthy subjects and patients with liver cirrhosis. The test is therefore suitable for the quantitative analysis of liver functions.

Cure of H. pylori infection using a 7-day triple therapy combining pantoprazole with two antibiotics

BACKGROUND

Acid pump inhibitors combined with antimicrobials cure gastritis and peptic ulcer disease but a standard therapy has not yet been established. We therefore investigated a triple therapy with pantoprazole.

METHODS

The aim of this open-label monocenter trial, involving 30 intention-to-treat patients with peptic ulcer disease or functional dyspepsia, was to assess the H. pylori cure rate after a 7-day triple therapy with pantoprazole (40 mg bid) plus metronidazole (500 mg bid) and amoxicillin (1 g bid). The H. pylori status was assessed by rapid urease test, histological examination and culture at the initial examination and by histological examination and culture at the study end 4 weeks after ending all therapy.

RESULTS

At the end of the trial H. pylori was eradicated in 21 of 27 per protocol patients (78%; 95% CI 58-91%) and in 21 of 30 patients included in the trial (70%; 95% CI 51-85%). In 15 of 16 per protocol patients with metronidazole-sensitive strain (94%; 95% CI 70-100%) the infection was cured, but in contrast eradication was accomplished in only one of 3 patients with a metronidazole-resistant H. pylori strain. Post-treatment resistance to metronidazole was observed in 6 cases, although 4 of them had had H. pylori strains sensitive to metronidazole at the initial visit. The gastritis had clearly been improved, and the activity of gastritis had completely disappeared 4 weeks after treatment. Seven adverse events were observed in 7 patients, the intensity of which was moderate in 6 cases.

CONCLUSIONS

This short-term triple therapy with pantoprazole, amoxicillin and metronidazole provides an effective regimen especially in patients with metronidazole-sensitive strain.

[Increased occurrence of esophageal hypermotility disorders in patients with arterial hypertension]

BACKGROUND AND OBJECTIVE

It has been noted in previous manometric examinations of the oesophagus in patients with chest pain that abnormal motility was often associated with arterial hypertension. A systematic study of this relationship was therefore undertaken.

PATIENTS AND METHODS

In 40 patients with chest pain (18 women and 22 men, mean age 54.7 [24-70] years) and in 20 healthy volunteers (12 men, 8 women, mean age 50.8 [22-63] years) standardized oesophageal manometry and arterial blood pressure monitoring were performed over 24 hours. Coronary heart disease and gastrointestinal lesions had been excluded by angiography and endoscopy, respectively.

RESULTS

20 patients (group H) had hypertension (median 24-hour blood pressure > 135/85 mmHg), while 20 patients (group N) and the normal controls (group K) were normotensive. Oesophageal manometry data differed significantly between the three groups regarding distal pressure amplitude (in hPa [hectopascals]; group H: 62 hPa*,**, group N 44 hPa* and group K 36 hPa**; [*P < 0.0005]) and the proportion of simultaneous contractions (group H 23%, group N 22%**, group K 10%***; ***P < 0.001). The hypertensive patients had significantly more frequent motility abnormalities than normal controls (13/20 vs 4/20, P < 0.001); while normotensive patients had more frequent episodes of abnormal propulsion in the oesophagus (proportion of propulsive contractions in group H: 53%, in N: 44%, in K: 59%; P < 0.01).

CONCLUSION

Oesophageal motility differed significantly in patients with chest pain from that in healthy controls. Patients with chest pain and hypertension more frequently had oesophageal hypermotility. This suggests a generalized abnormality of smooth muscle.

[Short-term triple therapy with pantoprazole, clarithromycin and metronidazole for the healing of Helicobacter pylori infection]

In a prospective study 27 patients (13 women, 14 men; mean age 62 [45-83] years) with Helicobacter (H.) pylori associated disease received over 7 days pantoprazole (40 mg twice daily), clarithromycin (500 mg twice daily) and metronidazole (500 mg twice daily). Six patients had gastric ulcer, 4 duodenal ulcer, 4 erosive gastritis, 6 erosive duodenitis and 7 had H. pylori-positive functional dyspepsia. Pre-treatment oesophago-gastro-duodenoscopy was combined in 4 patients with antral and in 4 others with body-of-stomach biopsies to demonstrate H, pylori (urease test, specific culture and histology). The H. pylori status was checked with the 13C-urea breath test 4 weeks after the end of treatment. In addition, 9 patients with peptic ulcer were examined endoscopically at least 2 weeks after onset of the treatment to check for any healing of the ulcers, 25 of the patients completed the study according to the protocol. The H. pylori eradication rate was 100% (25 of 25 patients), while the "intention to treat" analysis gave a rate of 92.6% (25 of the 27 patients). The peptic ulcers were found to be healed in all 9 patients who had been endoscoped. One woman developed a reversible stomatitis, but the drug treatment did not have to be stopped. -These findings indicate that short-term triple treatment in the described manner is efficacious in curing H. pylori infection and any peptic ulcer. It is thus a highly promising treatment of H. pylori-associated diseases.

Influence of high density lipoprotein (HDL), prepared from human blood, on prostanoid formation, serum and tissue lipids and development of arteriosclerosis in cholesterol rich fed rabbits

The i.v. administration of high density lipoprotein (HDL) into cholesterol fed rabbits decreased statistically significantly the serum level of total cholesterol and of low density lipoprotein cholesterol after a feeding period of 8 weeks. These diminished levels of cholesterol were associated with a statistically significant reduction in the levels of cholesterol esters in kidneys and platelets but not in hepatic tissue or in aorta. Macroscopically detectable arteriosclerosis was not statistically significantly diminished. The formation of prostanoids by the aorta remained unchanged. The atherogenic role of immunologic factors acting against the heterologous HDL may have compensated for the antiatherogenic HDL action on plasma and tissue lipids.

[Changes in the spongiosa density in the femoral head of rabbits in atherosclerosis]

Modulations of spongiosa density in the femoral head of rabbits by atherosclerosis. In a long-term study 31 rabbits (+5 control animals) were fed about 20 weeks on a diet rich in cholesterol. An important observation in this study was, that spongiosa density in the femoral head decreases after cholesterol rich diet in contrast to the control group. This effect could be modulated by the Trapidil AR 12463 content (50 mg/die) of the diet, but not by the high density lipoprotein application. Serum cholesterol levels and induced atherosclerosis were determined. Correlations between spongiosa density and atherosclerosis were discussed.

Transitional cell carcinoma of the urethra metastatic to the eyes in a dog

Hyphema and secondary glaucoma were ocular manifestations of disseminated neoplasia in a 4-year-old dog. The dog was euthanatized following enucleation after disseminated intravascular coagulopathy had developed. The histopathologic diagnosis was transitional cell carcinoma of the urethra, with metastasis to the lungs, heart, adrenal gland, and eyes.

Membrana nictitans gland cyst in a dog

A cyst involving the gland of the 3rd eyelid was removed from an 8-year-old dog. Clinically the circumscribed mass resembled a pigmented neoplasm. Histologically the cyst was multiloculated, with homogeneous eosinophilic periodic acid-Schiff-positive content. Melanin pigment was present in epithelial cells and cystic lumens. Protective functions of the 3rd eyelid were retained following excisional biopsy.