Heterotopic Gastric Mucosa in the Proximal Esophagus (Inlet Patch): Endoscopic Prevalence, Clinico-pathological Characteristics and Its Association with Helicobacter pylori

Objective To determine the prevalence of the inlet patch (IP), its clinico-pathological features, and its association with Helicobacter pylori.

Materials and Methods A prospective observational study was performed on 1,889 patients referred for esophagogastroduodenoscopy for various reasons, primarily for the evaluation of dyspepsia. All patients were enquired about the presence of symptoms and carefully examined for the presence of IP during upper gastrointestinal (GI) endoscopy. Biopsies were taken from the patients who had IP.

Statistical Analysis All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) 13.0 software for Windows XP. Categorical variables were compared using the chi-squared test or Fisher's exact test and continuous variables were compared using Student's t-test and univariate analysis. A P-value of less than 0.05 was considered to be statistically significant.

Results Inlet patches were found in 34 of 1,889 patients (1.8%). H. pylori was identified in 23.52% of patients (8/34) with IP. Gastric H. pylori infection was positive in all (08/08) patients who had IP. Colonization of H. pylori was more common in antral type mucosa (6/8). H. pylori positivity in the IP correlated with globus sensation symptom in our study, 87.5% of patients with IP and H. pylori positive had globus sensation.

Conclusion The prevalence of IP seems to be underestimated. H. pylori colonization of the IP is common and it positively correlates with globus sensation and is closely related to the H. pylori density in the stomach. Though preneoplasia within IP is rare, which does not support the recommendation to regularly obtain biopsies for histopathology, it might be beneficial in a subset of patients with persistent globus sensation.

Enhancing mutant IKS channel activity by increasing endogenous PIP2 levels and its interaction with PKA signalling pathway

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

Phosphatidylinositol-4,5-biphosphate (PIP2) is implicated in the regulation and modulation of the IKS channel. The channel is formed at the plasma membrane by the co-assembly of KCNQ1 and KCNE1. Patients with Congenital Long QT 1(LQT1) syndrome are predisposed to Polymorphic VT due to mutations in KCNQ1, leading to impaired channel activity.

We initially transfect Human Embryonic Kidney (HEK) cells with a mammalian vector expressing KCNQ1 gene tagged with green fluorescent protein, along with KCNE1 to form the wild type (WT) IKS channel. The cells were also transfected with a constitutively active PI(4)P 5-kinase(PIP5K), which converts the phospholipid Phosphatidylinositol-4-phosphate to PIP2, therefore increasing endogenous levels of PIP2. To ensure the enzyme remains localised at the plasma membrane we attached it to CFP-FKBP and we co-transfected the cells with Lyn11-FRB construct that tethers to the plasma membrane. When these cells were perfused with Rapamycin it induced chemical dimerization of CF-PIP5K to lyn11. We utilised an inactive PIP5K as a control. Mutants were created with a site directed mutagenesis kit.

In the presence CF-PIP5K, whole cell voltage clamp recordings demonstrated a 2.5 fold statistically significant increase in WT channel activity (at +80mV,p < 0.001), when compared to unaltered PIP2 conditions. Heterozygous Serine566phe and Phe340del mutants had statistically significant reduction in current density compared to wild type in basal conditions. When these mutants were expressed with the active CF-PIP5K, Serine566phe and Phe340 had a 2.97 and 3.30 fold increase in current density, respectively (p <0.05). Homozygous Mutants D242N and T247in also showed statistically significant channel activity.

We substituted serine with alanine at site 27 and 92(S27A/S92A) to generate a mutant known to disrupt cAMP mediated upregulation, there was a statistical 3.3 fold (80 + mV) increase in current density when co-expressed with CF-PIP5K. We then substituted serine with aspartic acid (S27D/S92D) to create a Phosphomimetic mutation, this mutant reproduces the effects of sympathetic mediated augmentation of IKS channel. In the presence of enhanced PIP2 levels, the S27D/S92D failed to demonstrate a statistical increase in current, implying the channel is at its maximum activity and hence we failed to observe any further modulation.

We then proceeded to interrogate how PIP2 interacts with sympathetic signalling system. Pseudojanin(PJ) causes depletion of PIP2 hence perturbing channel activity. When PJ was expressed with KCNQ1 and KCNE1 we observed an 80% reduction in channel activity at +80mV(P <0.001). When we perfused these cells with isoprenaline the channel activity was restored to normal.

Here we illustrate how increasing PIP2 levels can revive IKS channel activity in mutant genotype, therefore supporting evidence of its capabilities as a potential therapeutic tool. This modulation is independent of the PKA-cAMP system. Abstract Figure. Current Increment

Intracystic papillary carcinoma of the male breast: Dilemmas in diagnosis and management

Intracystic papillary carcinoma (IPC) is a rare malignancy of the breast which is usually found in postmenopausal women. It is still rarer in males and may present with signs of a benign cystic lump. It is sub-classified into three equally prevalent groups considering treatment strategies: intracystic papillary carcinoma alone, intracystic papillary carcinoma with ductal carcinoma in-situ, and those with evidence of invasion. Even if a preoperative diagnosis is achieved, there are no specific guidelines for the treatment of IPC. Treatment modalities including the extent of surgical excision, lymph node dissection, radiation, and chemotherapy are determined by the grade and size of the lesion and sub-types. However, several reports and studies showed good prognosis with conservative surgery without axillary dissection in IPC not associated with carcinoma in situ or micro-invasion. We present a 40 years old male patient with IPC who was managed by modified radical mastectomy and adjuvant hormone therapy. A brief review of the literature and clinical characteristics, pathology, and treatment of IPC are discussed.

Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia

To report convergence excess esotropia (CEET) following 0.01% atropine eye drops (Low dose atropine [LDA]). Children who developed CEET that resolved promptly after discontinuation of LDA are described. Three myopes aged 5.3 ± 1.2 years and mean sphere -4.5D were included. All were operated for intermittent exotropia earlier. Mean esotropia was +28.3PD for near and 10.6PD for distance. LDA induced high AC/A ratio and fusion normalized in 3 weeks after discontinuation of LDA. LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia. Any evidence of the emergence of a CEET should warrant discontinuation of LDA.

Estimation Dynamic Distance Direct Ophthalmoscopy (eDDDO): A novel, objective method for the quantitative assessment of accommodation in young children

Purpose

To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children.

Methods

In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner.

Results

For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45).

Conclusion

eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.

Allergic reactions to atropine eye drops for retardation of progressive myopia in children

Purpose

To report clinical manifestations of ocular allergy to atropine eye drops used for retardation of progressive myopia in children.

Methods

Myopic children, who developed bothersome itching that subsided promptly after cessation of atropine eye drops, were included. History of systemic or ocular allergy, preexisting ocular conditions, and clinical features of allergy were noted.

Results

Six children, age 5-15 years, were included. Four developed allergy to 1% atropine sulfate eye drops and two to 0.01% concentration of atropine sulfate. The onset of allergy was within a month to as late as 4 years after using atropine eye drops. The severity of allergy was higher with 1% concentration. The most common symptoms of atropine allergy were itching and burning. The most common signs were lid swelling and hyperemia. The allergic manifestations promptly reversed with the stoppage of eye drops. Reintroduction was possible in three patients, either by reducing the concentration of atropine or using benzalkonium free formulation.

Conclusion

Allergy to atropine eye drops in children may develop within a few weeks or after many years of usage. Prompt cessation followed by a reintroduction and continuation of therapy may be possible in few patients.

57Fe internal field nuclear magnetic resonance and Mössbauer spectroscopy study of Li-Zn ferrites

We report the internal field nuclear magnetic resonance (IFNMR) and Mössbauer spectroscopy study of Li-Zn ferrites at RT. The results were supported by the IFNMR data measured at 77 K. As Zn concentration increases the IFNMR echo amplitude decreases and below certain Zn concentration no signal was detected. At RT the echo amplitude vanishes at a lower Zn concentration, whereas at 77 K, the echo amplitude does not vanish completely (except for pure Zn-ferrite). However, in Mössbauer spectroscopy at RT, we have observed magnetically ordered state of all the Li-Zn ferrite samples. This discrepancy could be related to the difference between the time scale of detection of the spins by Mössbauer spectroscopy (10^-7-10^-10 s) and NMR spectroscopy (10^-6 s). Hence, sensitivity of zero-field NMR depends on the magnetic hyperfine field, temperature and abundance of the magnetic cations at the lattice of the spinel ferrites. We have demonstrated that the 'two-equal-pulses' sequence leads to higher echo signal than the spin echo pulse sequence due to the presence of distribution of internal magnetic fields throughout the material. We obtained a limiting value for the fraction of spins needed to produce an echo signal at a particular temperature and at a particular site of the Li-Zn ferrite spinels that can be sensitively detected by pulsed IFNMR technique.

Efficacy of 1% atropine eye drops in retarding progressive axial myopia in Indian eyes

Purpose:

The aim of this study is to assess the efficacy of 1% atropine eye drops for the retardation of progressive axial myopia in Indian eyes.

Methods:

This prospective interventional cohort study included children aged 5–16 years. Both the eyes of myopic children with progressive increase of ≥−0.5D sphere/year with the best-corrected vision of ≥6/6 were treated with once a day application of 1% atropine eye drops and progressive addition photogray lenses. The progression of myopia after 1-year follow-up was analyzed.

Results:

Sixty eyes of thirty myopes were included in the study. The mean age was 10 years and 15 were girls. The mean baseline sphere was −5.2D (−2.5D–−13D). Mean duration of follow-up was 23 months (12–36 months). The baseline rate of progression was reduced from −0.6D/year (range −0.5D/year to −3D/year) to −0.2D/year (range 0D/year to −1.5D/year) after atropine therapy. Seventeen patients (57%) had to use the atropine in the daytime to reach the target progression of <−0.5D/year. There was no difference between the efficacy of atropine drops in the boys and girls (P = 0.6). The efficacy of atropine drops did not have a correlation with the age of the patients or the magnitude of baseline myopia (Pearson's r = 0).

Conclusion:

1% atropine eye drops was well tolerated and efficacious for the retardation of progressive myopia in Indian eyes. Effectiveness was better with daytime application. Further studies are necessary to assess the role of 1% atropine in the rapid progressors and patients poorly responding to low-dose atropine.

Ultrasonography for masseter muscle cysticercosis

Solitary cheek swellings can present a diagnostic dilemma. We managed two children 10 y and 8 y presenting with pain and swelling on one side of cheek for over 15 d and no constitutional symptoms. Sonography showed cysticercosis in both of them. We treated both with steroids and albendazole, with good response.

Effect of water extract of the bark of Buchanania lanzan linn. on behaviour and chromatophores of a fresh water fish, Labeo rohita

Fish exposed to 150 ppm and 250 ppm doses saparately, showed eratic swimming with hyper-excitability, spiralling, convulsion and mortality. However at 350 ppm dose fish became lethargic and steady at the bottom of aquarium. This behaviour appears to be due to sedative effects of fish implicating the phychoactive nature of the plant B. Ianzan. At 150 ppm to 350 ppm doses, fish scale changed from reticulate to punctate chromatophores; and treated fish when transferred to fresh water, were slowly regained to normal behaviour after 96 h exposure. Hence doses regaining from 150 ppm to 350 ppm is considered to be psychoative in nature. In higher doses 450 ppm and 550 ppm fish could survive only 76 h and 4.30 h respectively and then died indicating toxicity of plant for the said doses. It is found that scale present on its body is most suitable test system for the study of psychoactivity and toxicity of plant extracts on fish, Labeo rohita.

Stent retriever for dilation of pancreatic and bile duct strictures. brand@uke.uni-hamburg.de

BACKGROUND AND STUDY AIMS

Dilation of high grade strictures of pancreatic or biliary ducts using dilating or balloon catheters may fail. We evaluated the efficacy of the 7-Fr Soehendra Stent Retriever used as a dilator.

PATIENTS AND METHODS

Following sphincterotomy, the stricture was first negotiated with a 260 cm long 0.032-inch J-type Terumo wire. Dilation was then attempted using a 7-Fr dilating catheter. If the stricture could not be traversed, the 7-Fr Stent Retriever was inserted over the Terumo wire to dilate the stricture. Between May 1996 and January 1997, the Stent Retriever was used for dilation in 32 patients with biliary or pancreatic duct strictures.

RESULTS

The indication for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was symptomatic chronic pancreatitis in 21 patients (twelve men, nine women; mean age 45.7, range 26-70). The mean length (+/-SD) of the pancreatic duct strictures was 20mm+/-10 (range 3-55) with a prestenotic ductal diameter of 9mm+/-2 (range 2-15). Out of 21 patients, nine suffered from pancreaticolithiasis and were treated with extracorporeal shock wave lithotripsy. All but three patients underwent successful stenting in the same session. Another 11 patients (four men, seven women; mean age 67.4, range 47-85) had cholestasis because of benign or malignant bile duct strictures. The mean length of the strictures was 20mm+/-5 (range 3-40), and the mean prestenotic diameter was 10mm+/-5 (range 4-21). Stenting was easily done in all of these patients in the same session. Symptom relief was observed within the first week after stenting in all patients with a biliary or pancreatic stricture. In seven cases, material for cytological examination was obtained from the bile duct, which revealed malignancy in two cases. There was no complication associated with the use of the Stent Retriever. One subcapsular liver perforation was caused by the guide wire and occurred prior to the use of the Retriever.

CONCLUSIONS

Tight pancreatic and bile duct strictures can be dilated successfully with the Stent Retriever. The procedure is of low risk. In addition, tissue sampling is possible in some cases.

Biotechnological production of oil: fatty acid composition of microbial oil

The fatty acid profile and the fatty acid composition of microbial lipids obtained from molds revealed that oil from Aspergillus sydowii, Fusarium oxysporum and F. equisetti had a high percentage of unsaturated fatty acids, particularly oleic acid, and had a similarity to the edible oils, groundnut and palm oil. This study sheds light on the possibilities of exploring the use of these oils as supplement to other edible fats and for other non-edible industrial purposes.

EUS-guided, fine-needle aspiration biopsy using a new mechanical scanning puncture echoendoscope

BACKGROUND

A new mechanical sector scanning echoendoscope designed for EUS-guided, fine-needle aspiration biopsy (FNAB) was prospectively evaluated. The technical feasibility, safety, and histocytologic FNAB results are reported.

METHODS

Eighty-six patients underwent 106 FNAB procedures. The new echoendoscope has a 2.8 mm accessory channel and an elevator. Target sites: pancreas 58, lymph nodes 43, and miscellaneous lesions 5. Lesions were punctured with a 0.7 mm needle and submitted for cytologic and histologic examination. Definitive diagnosis was by surgery or clinical follow-up.

RESULTS

The wide scanning field (250 degrees) enabled easy sonographic orientation for FNAB. Longitudinal needle visibility was "good" in 93% and 71% of transesophageal and transgastric procedures, respectively, but were compromised during most transduodenal procedures. Needle penetration of indurated pancreatic lesions failed in two patients, and in four additional patients pancreatic sampling succeeded only after a second attempt using an automated spring-loaded device. The mean number of passes was three. Ten percent of FNAB specimens were "inadequate"; excluding these, the diagnostic accuracy rate was 97%; sensitivity for malignancy was 88.5% and specificity was 100%.

CONCLUSION

EUS-guided FNAB is feasible, safe, and accurate using the new mechanical puncture echoendoscope. Needle visibility needs to be improved, particularly for transduodenal FNAB.

Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope

BACKGROUND

Previous studies have reported on endoscopic ultrasound-guided, fine needle aspiration biopsy using 22- to 25-gauge needles. We evaluated the histologic and cytologic yield of endoscopic ultrasound-guided, fine needle aspiration biopsy of the pancreas using an 18-gauge, Menghini-type core needle.

METHODS

Fine needle aspiration biopsy was performed in conjunction with a prototype 2.8 mm channel convex array echoendoscope. The core specimen was placed in formalin for cell block, and residual material was expelled on slides for cytology. Definitive diagnosis was established by surgery or clinical follow-up.

RESULTS

Of 45 patients who underwent fine needle aspiration biopsy, the needle failed to penetrate indurated pancreatic lesions in five. An average of 2.6 passes were performed in the remaining patients. Sufficient material for a histologic and/or cytologic diagnosis was obtained in 40 patients (histologic and cytologic yield of 68% and 75%, respectively). Combining the results of histology and cytology, the sensitivity and specificity for detection of malignancy was 76% and 100%, respectively. Histology confirmed the cytologic findings in 35 patients, providing additional tissue specific information. In three cases histology established a diagnosis of malignancy where cytology was not conclusively malignant. However, in three cases of surgically confirmed malignancy histology failed to detect malignancy, whereas cytology showed suspicious or malignant cells. The sensitivity of histology and cytology alone in detecting malignancy was 53% and 70%, respectively. Mild pancreatitis occurred after pancreatic fine needle aspiration biopsy in one patient.

CONCLUSION

Core specimens for histology can be safely obtained using an 18-gauge needle. Histology provides tissue-specific information that complements cytology, but histology is less sensitive than cytology in detecting malignancy.