A case of Jackhammer esophagus caused by eosinophilic esophagitis in which per-oral endoscopic myotomy resulted in symptom improvement

Abstract

A 73-year-old female with a 6-month history of progressive dysphagia and chest pain was referred to our hospital. She underwent esophagogastroduodenoscopy, which revealed abnormally strong contractions in the distal esophagus. Esophageal biopsy specimens showed massive eosinophil infiltration into the epithelium, and high-resolution manometry (HRM) also demonstrated abnormally strong contractions in the distal esophagus. Based on these results, she was diagnosed with Jackhammer esophagus (JHE) due to eosinophilic esophagitis (EoE). Treatment was started with 5 mg/day of prednisolone (PSL), and the number of peripheral blood eosinophils quickly decreased without any improvement in the patient's dysphagia. Esophageal biopsy specimens obtained after the PSL treatment showed the disappearance of eosinophils from the epithelium. However, abnormally strong contractions were still detected on HRM. Per-oral endoscopic myotomy (POEM) was performed to treat the JHE. Interestingly, the intraoperative esophageal muscle biopsy sample demonstrated massive eosinophil infiltration into the muscle layer. After the POEM, the patient's symptoms improved, and abnormal contractions were no longer detected on HRM. The current case suggests that when EoE combined with an esophageal motility disorder are refractory to steroid therapy, clinicians should be aware that motility disorders can develop due to eosinophil infiltration deep into the esophageal muscularis propria.

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Effect of Porins and blaKPC Expression on Activity of Imipenem with Relebactam in Klebsiella pneumoniae: Can Antibiotic Combinations Overcome Resistance?

Microbial Drug Resistance, Ahead of Print.


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Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae from Bangkok, Thailand, and Their Detection by the Carba NP and Modified Carbapenem Inactivation Method Tests

Microbial Drug Resistance, Ahead of Print.


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Colonization with Enterobacteriaceae-Producing ESBLs, AmpCs, and OXA-48 in Wild Avian Species, Spain 2015–2016

Microbial Drug Resistance, Ahead of Print.


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TOTALLY LAPAROSCOPIC, MULTI-STAGE, RESTORATIVE PROCTOCOLECTOMY FOR INFLAMMATORY BOWEL DISEASES. A PROSPECTIVE STUDY ON SAFETY, EFFICACY AND LONG-TERM RESULTS

Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.

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Lumbar discectomy is associated with higher rates of lumbar fusion

Lumbar disc herniation affects over three million people in the United States every year, and the rate of operation continually increases, particularly in patients 60 years or older.1,2 Surgical discectomy is a common treatment for lumbar disc herniation.1,3 One concern for this method is the risk of undergoing additional surgeries. 2,5,7 There are very limited population-level studies that examine the rate of lumbar fusion following lumbar discectomy. Additionally, there is no study that examines the risk of undergoing lumbar fusion in patients who have undergone lumbar discectomies compared to the risk of lumbar fusion in the general population with no previous lumbar discectomy.

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Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries

Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains controversial, resulting in practice-based variation.

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Frailty status as a predictor of three month cognitive and functional recovery following spinal surgery: a prospective pilot study

Background ContextAs increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome which has been closely linked to poor outcomes, and short form screening may be a helpful tool for preoperative identification of at risk patients.PurposeTo conduct a pilot study on the usefulness of a short-form screening tool to identify elderly patients at increased risk for prolonged cognitive and functional recovery following elective spine surgery.

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Responsiveness of the Japanese orthopaedic association back pain evaluation questionnaire in lumbar surgery and its threshold for indicating clinically important differences

Introduced in 2007, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) has been widely used, but its psychometric properties have not been well studied.

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Does solid fusion eliminate rod fracture after pedicle subtraction osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis?

Rod fracture (RF) has a negative impact on the surgical outcome of ankylosing spondylitis (AS) patients following lumbar pedicle subtraction osteotomy (PSO). However, there is a paucity of published studies analyzing the risk factors for RF in PSO-treated AS patients with thoracolumbar kyphosis.

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Risk factors for low back pain and sciatica: an umbrella review

Low back pain (LBP) is a highly prevalent condition and it is associated with significant disability and work absenteeism worldwide. A variety of environmental and individual characteristics have been reported to increase the risk of low back pain (LBP). To our knowledge, there has been no previous attempt to summarise the evidence from existing systematic reviews of risk factors for LBP and/or sciatica

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BMI and gender increase risk for sacral fractures after multilevel instrumented spinal fusion compared to bone mineral density and pelvic parameters

Sacral fractures are a rare but potentially devastating complication. Long-fusion constructs including the sacrum that do not extend to the pelvis may result in sacral fractures. Besides established risk factors including gender, age and number of levels fused, body mass index (BMI), pelvic parameters and bone mineral density (BMD) have also been proposed as potential risk factors for postoperative sacral fractures. The literature supporting this, however, is limited.

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Cervical bracing practices after degenerative cervical surgery: a survey of cervical spine research society members

Context: Prior studies have shown common use of post-operative bracing, despite advances in modern day instrumentation rigidity and little evidence of brace effectiveness.

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Effect of a bisphosphonate and selective estrogen receptor modulator on bone remodeling in streptozotocin-induced diabetes and ovariectomized rat model

Diabetes and menopause can cause severe osteoporosis. In general, menopause and diabetes can lead to an imbalance in bone turnover, which results in secondary osteoporosis. However, the efficacy of antiresorptive drugs against this form of osteoporosis has not been extensively evaluated.

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Addendum: Campos D, Peeters W, Nickel K, Burkel B, Bussink J, Kimple RJ, van der Kogel A, Eliceiri KW, KissickMW. “Radiation Promptly Alters Cancer Live Cell Metabolic Fluxes: An In Vitro Demonstration.” Radiat Res 2016; 185:496-504.

Radiation Research, Volume 189, Issue 6, Page 668-668, June 2018.


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Some like it hot — sex determination in turtles

Some like it hot — sex determination in turtles

Some like it hot — sex determination in turtles, Published online: 21 May 2018; doi:10.1038/s41576-018-0023-0

A recent study in Science reports the mechanism by which temperature affects sex determination in the red-eared slider turtle, Trachemys scripta elegans.

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Prolonged forearm ischemia attenuates endothelium-dependent vasodilatation and plasma nitric oxide metabolites in overweight middle-aged men

Abstract

Purpose

Repeated cycles of endothelial ischemia–reperfusion injury and the resulting respiratory burst contribute to the irreversible pathophysiology of vascular diseases, and yet, the effects of ischemia reperfusion on vascular function, oxidative stress, and nitric oxide (NO) bioavailability have not been assessed simultaneously. Therefore, this study sought to examine the effects of prolonged forearm occlusion and subsequent reperfusion on NO-dependent brachial artery endothelial function.

Methods

Flow-mediated dilatation was measured at baseline and 15, 30, and 45 min after 20-min forearm occlusion in 14 healthy, but physically inactive middle-aged men (53.7 ± 1.2 years, BMI: 28.1 ± 0.1 kg m⁻²). Venous blood samples collected from the occluded arm were analyzed for NO metabolites and markers of oxidative stress.

Results

FMD was significantly depressed after the prolonged occlusion compared to baseline, with a significant reduction 15-min post-occlusion (6.6 ± 0.7 to 2.9 ± 0.4%, p < 0.001); FMD remained depressed after 30 min (4.1 ± 0.6%, p = 0.001), but was not significantly different to baseline after 45-min recovery (5.4 ± 0.7%, p = 0.079). Plasma nitrate (main time effect: p = 0.015) and nitrite (main time effect: p = 0.034) concentrations were significantly reduced after prolonged occlusion. Plasma catalase activity was significantly elevated at 4- (p = 0.016) and 45-min (p = 0.001) post-occlusion, but plasma peroxiredoxin 2 and protein carbonyl content did not change.

Conclusions

Prolonged forearm occlusion resulted in acute impairment of endothelium-dependent vasodilatation of the brachial artery for at least 30 min after reperfusion. We demonstrate that this vascular dysfunction is associated with oxidative stress and reduced NO bioavailability following reperfusion.

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Some like it hot — sex determination in turtles

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Empire State Building to light up for EMS Week

The Empire State Building will be illuminated in yellow, white and blue with a red and white halo at sunset

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Celebrate EMS Week 2018 with EMS superlatives

You know who they are – recognize the Ferdinand Magellans, Yodas and Cliff Clavens of your agency during EMS Week

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Investing in public health—driving prosperity for the present and future generations

Countries across Europe and the World are faced with growing health, inequity, social security, economic and environmental challenges. We need urgent, innovative and priority-focused investment to ensure sustainable development for the present and future generations. Doing business as usual is unsustainable with high costs for individuals, families, communities, society, the economy and the planet. Governments can have a major impact on all factors influencing health and wellbeing, on the way people live and on their everyday choices. The interconnected nature of current challenges and possible solutions needs strong leadership, strategic and political commitment, and coherent action. It also requires new approaches and financing mechanisms building on cross-sector collaboration and citizen involvement in decision-making, i.e. participatory governance for health.

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Sleep pirates–are we really living through a sleep deprivation epidemic and what’s stealing our sleep?

There is a joke that is used to warn students about the dangers of ecological associations involving the (historical) 'causal link' between the declining numbers of pirates and increasing global warming. A key problem with this joke is that there are very few pirates left in the world: an assumption that is seldom questioned. Likewise in the field of sleep epidemiology, one of our key until recently untested assumptions is that a worldwide secular decline in sleep durations exists (the sleep deprivation epidemic). The problem is now that whilst the assumption is widely held numerous studies around the world using detailed time-use survey data have failed to confirm that adults in developed nations are sleeping less than they were a generation ago.¹ Indeed the very recent good news from the USA is that average sleep durations have continued to subtlety rise through the last decade.² Updated analyses of the time use survey data there indicate that between 2003 and 2016 average workday sleep durations have increased by about 1.4 min per year and weekend sleep by 0.8 min per year. Encouragingly for public health the authors suggest that people have been successfully convinced to go to sleep earlier.

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European Public Health News

In this European public health news, Azzopardi Muscat and Jakab are talking about the control of NCDs. Even though progress has been made, we need to act now, we need co-ordinated efforts and bold public health measures. The need for co-ordinated efforts is also addressed by Andriukaitis who is presenting the newly adopted Commission proposal to cooperate on health technology assessments in order to bring innovative health solutions faster to patients. The necessity of a strong voice and a multi-disciplinary, co-ordinated approach also applies to violence, as described by Zeegers. All these contributions ask for public health professionals to be innovate, collaborative and ready to learn from each other. Our new EUPHAnxt team is doing just that and the upcoming Ljubljana 2018 conference (Erzen) will showcase our successes as well as our 'successful failures'.

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The characteristics of small intestinal bacterial overgrowth in patients with gallstone diseases

Journal of Gastroenterology and Hepatology

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Level of hepatitis B (HB) core antibody associates with seroclearance of HBV DNA and HB surface antigen in HB e antigen-seronegative patients

Clinical Gastroenterology and Hepatology

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Serologic responses and effectiveness of hepatitis A vaccination among human immunodeficiency virus–positive individuals during the outbreak of acute hepatitis A

Hepatology

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Hepatitis E seroprevalence in the Americas: A systematic review and meta-analysis

Liver International

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Comparative effectiveness of adjuvant treatments for resected gastric cancer: A network meta-analysis

Gastric Cancer

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Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients

Abstract

Purpose

The aim of this study was to elucidate the relationship between the onset of rocuronium-induced neuromuscular block and arterial pressure-based cardiac output (CO) in elderly patients.

Methods

Forty elderly patients aged 65–83 years were enrolled in this study. After induction of anesthesia, contractions of the adductor pollicis muscle to ulnar nerve train-of-four stimulation were acceleromyographically evaluated and 1 mg/kg rocuronium was administered following CO measurement. The correlation between onset of rocuronium action and CO was analyzed.

Results

The mean [SD] CO reduced after induction of anesthesia from 5.1 [1.8] L/min to 3.8 [1.1] L/min. The onset time of rocuronium-induced neuromuscular block was 110.3 [23.9] s (range 60–165). There was a statistically significant inverse correlation between the onset time of rocuronium and CO [onset time (s) = − 13.2·CO + 159.7, R² = 0.376].

Conclusions

In the elderly, CO influences the onset of action of rocuronium.

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Endothelium-dependent vasodilation in the cerebral arterioles of rats deteriorates during acute hyperglycemia and then is restored by reducing the glucose level

Abstract

Purpose

Acute hyperglycemia in patients with traumatic brain injury correlates with a poor neurological outcome. We investigated the endothelium function of rat cerebral arterioles during acute hyperglycemia and after reducing the glucose levels using insulin. We also examined whether or not oxidative stress was involved in the cerebral arteriole response to acute hyperglycemia.

Methods

In isoflurane-anesthetized, mechanically ventilated rats, we used closed cranial window preparation to measure the changes in the pial arteriolar diameter following the topical application of acetylcholine (ACh) or adenosine. We examined the pial arteriolar vasodilator response before hyperglycemia, during hyperglycemia, and after reducing the glucose level using insulin. After intravenous pretreatment with an NADPH oxidase inhibitor (apocynin or diphenylene iodonium), we reexamined the pial arteriolar vasodilator response following the topical application of ACh.

Results

Under control conditions, the topical application of ACh dose-dependently dilated the cerebral arterioles. The vasodilatory responses to topical ACh were impaired during hyperglycemia and improved after the administration of insulin. The vasodilatory responses to topical adenosine were not affected by the glucose levels. In the apocynin or diphenylene iodonium pretreatment group, the topical application of ACh dilated the cerebral arterioles during hyperglycemia.

Conclusion

Acute hyperglycemia induces a dysfunction of the endothelium-dependent vasodilation of rat cerebral arterioles. The dysfunction can be reversed by improving the acute hyperglycemia and it can be prevented entirely by the administration of NADPH oxidase inhibitors. These results could suggest that controlling the glucose levels works protectivity to endothelium function of cerebral arterioles.

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