Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale

Abstract

Background

Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer.

Materials and Methods

This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting.

Results

There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer.

Conclusions

This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer.

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Cologastric strictures: What is the best treatment?

A 31-year-old gentleman who had undergone an emergent esophagectomy and reconstruction with a colon interposition graft, presented with a long-standing cologastric stricture. He had undergone multiple attempts at endoscopic dilation over multiple decades with little symptomatic relief. He underwent a resection and reconstruction of the anastomosis entirely through an abdominal approach. He did well from surgery and experienced complete symptomatic relief immediately. Complications of colon interposition grafts can occasionally be treated using an abdominal incision only.

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Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft

The rising use of endovascular techniques utilizing femoral artery access may increase the frequency with which surgeons face the challenge of hernia repair in reoperative groins—which may or may not include a vascular graft. We present a case where a vascular graft contributed to an acute presentation and complicated dissection, and review the literature. A 67-year-old man who had undergone prior endovascular aneurysm repair via open bilateral femoral artery access and concomitant prosthetic femorofemoral bypass, presented with an incarcerated, scrotal inguinal hernia. The graft with its associated fibrosis contributed to the incarceration by compressing the inguinal ring. Repair was undertaken via an open, anterior approach with tension-free, Lichtenstein herniorraphy after releasing graft-associated fibrosis. Repair of groin hernias in this complex setting requires careful surgical planning, preparation for potential vascular reconstruction and meticulous technique to avoid bowel injury in the face of a vascular conduit and mesh.

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Linea arcuate hernia disguised as Pfannenstiel incision's hernia: a case report and a systemic literature review

We report a rare case of a 46-year-old woman 2 weeks after a cesarean section with Pfannenstiel incision, who presented at the Emergency Department with a significant abdominal pain accompanied by two episodes of vomiting. After that a clinical examination and an abdominal computed tomography scan were completed, a visceral herniation through Pfannenstiel incision was suspected. The indication of surgical exploration was clear. Finally, the laparotomy revealed a linea arcuata hernia with a hernia of the small intestine. After a reduction of the hernia sac, the defect was repaired and no mesh was placed. An antibiotic treatment with co-amoxicillin for 1 week during the recovery was prescribed. The patient recovered uneventfully and could be discharged by postoperative day 7.

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Role of video-head impulse test in lateralization of vestibulopathy: Comparative study with caloric test

Publication date: Available online 8 January 2017
Source:Auris Nasus Larynx
Author(s): Pona Park, Joo Hyun Park, Ji Soo Kim, Ja-Won Koo
ObjectiveTo evaluate the lateralization value of video head-impulse test (vHIT) for the diagnosis of vestibulopathy and to analyze cases showing dissociated results with caloric test.MethodsIn total, 19 healthy volunteers and 92 dizzy patients who underwent both a caloric test and a vHIT were enrolled. Patients were divided into two groups depending on their fluctuating pattern of vertigo. The vestibulo-ocular reflex (VOR) gain and gain asymmetry (GA) of a vHIT as well as unilateral weakness (UW) and the sum of the slow-phase velocities (SPVs) of warm and cold irrigation of the same side were compared. A cutoff value of VOR gain of a vHIT was also calculated using a receiver-operating characteristic curve.ResultsA VOR gain in an affected ear and GA of a vHIT showed a statistically significant correlation with UW in a caloric test. The cutoff value of a vHIT was determined to be 0.875, derived under the assumption that UW of a caloric test ≤25% is normal. However, the parameters of the two tests were dissociated in 18%.ConclusionA VOR gain of vHIT is a valuable objective parameter with a lateralization value determining vestibular hypofunction. However, considering substantial dissociation between a vHIT and a caloric test, these tests can be complementary tools for the lateralization of vestibular impairment for the comprehensive evaluation of patients' VOR.



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Infratemporal fossa metastasis of colorectal carcinoma

Publication date: Available online 7 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eng Haw Lim, Irfan Mohamad, Ramiza Ramza Ramli, Bhavaraju Venkata Murali Krishna
Metastatic disease of colorectal carcinoma can be present at the time of initial diagnosis or develop along the course of the disease. The liver is the most common site of distant metastasis of colorectal carcinoma. Other sites that are frequently involved include lung, peritoneum and bone. Head and neck involvement is extremely rare. We report a case of a middle-aged lady who was treated for colorectal carcinoma presented with infratemporal fossa metastasis 3years after the diagnosis of rectal carcinoma.



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Primary large cell neuroendocrine carcinoma of the larynx

Publication date: Available online 7 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): N. Maithrea, Sandie Ewe, K.C. Pua, Irfan Mohamad
Neuroendocrine tumours (NETs) can arise in most organs of the body but are most frequently recorded in the gastrointestinal tract or lungs. They are rarely found in the head and neck region. The commonest site in the head and neck region is in the larynx. NETS in the larynx are almost invariably primary in origin. We describe a case of a middle-aged gentleman, a chronic smoker who was diagnosed with primary large cell neuroendocrine carcinoma of larynx with cervical nodal metastases. Large cell neuroendocrine carcinoma of larynx is a rare subset of NETs with a markedly more aggressive clinical course. He was initially treated with radiotherapy, and subsequently underwent total laryngectomy, total glossectomy. Right radical neck dissection and reconstruction with pectoralis major myocutaneous flap.



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Role of video-head impulse test in lateralization of vestibulopathy: Comparative study with caloric test

To evaluate the lateralization value of video head-impulse test (vHIT) for the diagnosis of vestibulopathy and to analyze cases showing dissociated results with caloric test.

http://ift.tt/2i7ShjK

Incorporating body-type (apple vs. pear) in STOP-BANG questionnaire improves its validity to detect OSA

The aim of this study is to evaluate whether adding the item of "apple body type" to the STOP-BANG questionnaire enhances diagnostic performance of the questionnaire for detecting obstructive sleep apnea (OSA).

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Adenylyl cyclase type 9 gene polymorphisms are associated with asthma and allergy in Brazilian children

Publication date: February 2017
Source:Molecular Immunology, Volume 82
Author(s): Helena M.P. Teixeira, Neuza M. Alcantara-Neves, Maurício Barreto, Camila A. Figueiredo, Ryan S. Costa
Asthma is a chronic inflammatory disease of the respiratory tract. This heterogeneous disease is caused by the interaction of interindividual genetic variability and environmental factors. The gene adenylyl cyclase type 9 (ADCY9) encodes a protein called adenylyl cyclase (AC), responsible for producing the second messenger cyclic AMP (cAMP). cAMP is produced by T regulatory cells and is involved in the down-regulation of T effector cells. Failures in cAMP production may be related to an imbalance in the regulatory immune response, leading to immune-mediated diseases, such as allergic disorders. The aim of this study was to investigate how polymorphisms in the ADCY9 are associated with asthma and allergic markers. The study comprised 1309 subjects from the SCAALA (Social Changes Asthma and Allergy in Latin America) program. Genotyping was accomplished using the Illumina 2.5 Human Omni bead chip. Logistic regression was used to assess the association between allergy markers and ADCY9 variation in PLINK 1.07 software with adjustments for sex, age, helminth infection and ancestry markers. The ADCY9 candidate gene was associated with different phenotypes, such as asthma, specific IgE, skin prick test, and cytokine production. Among 133 markers analyzed, 29 SNPs where associated with asthma and allergic markers in silico analysis revealed the functional impact of the 6 SNPs on ADCY9 expression. It can be concluded that polymorphisms in the ADCY9 gene are significantly associated with asthma and/or allergy markers. We believe that such polymorphisms may lead to increased expression of adenylyl cyclase with a consequent increase in immunoregulatory activity. Therefore, these SNPs may offer an impact on the occurrence of these conditions in admixture population from countries such as Brazil.



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Compensated Vestibular Dysfunction Post Cochlear Implantation in Children with Sensorineural Hearing Loss: A Prospective Study

Abstract

Children with sensorineural hearing loss have risk of surgically induced vestibular dysfunction post cochlear implantation due to instrumentation. It is clinically important to estimate the risk of vestibular loss post cochlear implant so the patient can be made fully aware of these risks when considering cochlear implantation. The aim of the study was to identify compensated vestibular dysfunction post cochlear implantation. Vestibular function was evaluated both pre and post CI using monothermal warm air caloric testing. Recordings were made using head band camera on SYNAPSYS Ulmer VNG software. 'Monothermal caloric asymmetry' (MCA) was depicted as 'unilateral weakness' based on the slow phase velocity of nystagmus. MCA of >15% was taken as evidence of canal paresis. The incidence of compensated vestibular dysfunction post CI surgery was found to be 16.66%. The results were statistically significant (p value 0.02) and indicated worsening of canal paresis indicative of vestibular dysfunction. Children for cochlear implantation should undergo evaluation of their vestibular system pre and post surgery. Caution should be exercised before planning bilateral cochlear implantation in the same sitting.

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Cholesterol granuloma of ethmoid sinuses: Report of two cases

Publication date: Available online 7 January 2017
Source:Acta Otorrinolaringológica Española
Author(s): Nadim Khoueir, Alan Shikani




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Effect of nasal allergen challenge in allergic rhinitis on mitochondrial function of peripheral blood mononuclear cells

Publication date: Available online 7 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Shanshan Qi, Cindy Barnig, Anne-Laure Charles, Anh Poirot, Alain Meyer, Raphaël Clere-Jehl, Fréderic de Blay, Bernard Geny




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Underuse of allergy services for patients having systemic reactions to Hymenoptera venom stings

Publication date: Available online 7 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anil M. Patel, Vivian Wang, Ami Philipp, Joseph S. Yusin




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In situ effect of enamel salivary exposure time and type of intraoral appliance before an erosive challenge

Abstract

Objectives

This study tested the effect of enamel salivary exposure time prior to an acid challenge (30 min, 1, 2, or 12 h) and type of intraoral appliance (palatal or mandibular) on initial erosion.

Methods

After initial surface hardness evaluation, enamel blocks (n = 340) were randomly divided into groups and volunteers (n = 20). The control group was not exposed to saliva previously to the erosive challenge. The volunteers wore palatal and mandibular appliances simultaneously. After salivary exposure, the blocks were subjected to acid exposure by immersion in hydrochloric acid (0.01 M, pH 2.3) for 30 s. Then, the enamel surface hardness was evaluated. Data were analyzed using ANOVA, Kruskal–Wallis and Tukey's test (p < 0.05).

Results

No difference was observed on percent surface hardness change (% SHC) in the enamel blocks between the types of intraoral appliances. Exposure to saliva for 30 min and 1 h promoted similar enamel resistance to the erosive attack, which was similar to the control group for both appliances. Blocks exposed to saliva for 2 h showed less hardness loss when compared to 30 min. Keeping the blocks in saliva during 12-h overnight resulted in similar percentage of enamel hardness loss compared to 2 h.

Conclusions

A 2-hour in situ exposure to saliva is adequate to promote partial protection against initial erosive lesions, independently of the type of intraoral appliance used.

Clinical significance

This finding will help researchers in the development of erosion studies, which will provide information for dentists to offer a better treatment for erosion.

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