Can Optic Nerve Sheath Images on a Thin-Slice Brain Computed Tomography Reconstruction Predict the Neurological Outcomes in Cardiac Arrest Survivors?

We analyzed the prognostic performance of optic nerve sheath diameter (ONSD) on thin-slice (0.6 mm) brain computed tomography (CT) reconstruction images as compared to routine-slice (4 mm) images. We conducted a retrospective analysis of brain CT images taken within 2 h after cardiac arrest. The maximal ONSD (mONSD) and optic nerve sheath area (ONSA) were measured on thin-slice images, and the routine ONSD (rONSD) and gray-to-white matter ratio (GWR) were measured on routine-slice images. We analyzed their area under the receiver operator characteristic curve (AUC) and the cutoff values for predicting a poor 6-month neurological outcome (a cerebral performance category score of 3-5). Of the 159 patients analyzed, 113 patients had a poor outcome. There was no significant difference in rONSD between the outcome groups (p = 0.116). Compared to rONSD, mONSD (AUC 0.62, 95% CI: 0.54-0.70) and the ONSA (AUC 0.63, 95% CI: 0.55-0.70) showed better prognostic performance and had higher sensitivities to determine a poor outcome (mONSD, 20.4% [95% CI, 13.4-29.0]; ONSA, 16.8% [95% CI, 10.4-25.0]; rONSD, 7.1% [95% CI, 3.1-13.5]), with specificity of 95.7% (95% CI, 85.2-99.5). A combined cutoff value obtained by both the mONSD and GWR improved the sensitivity (31.0% [95% CI, 22.6-40.4]) of determining a poor outcome, while maintaining a high specificity. In conclusion, rONSD was clinically irrelevant, but the mONSD had an increased sensitivity in cutoff having acceptable specificity. Combination of the mONSD and GWR had an improved prognostic performance in these patients.

Endoscopic Characteristics of Rugal Hyperplasia and Related Acid Condition in Helicobacter pylori-Infected Stomach.

BACKGROUND/AIMS: Rugal hyperplastic gastritis (RHG) is associated with Lauren's diffuse-type gastric cancer (GC) and the accompanying active inflammation is linked to gastric hypoacidity. We tried to establish the steps for identifying high-risk GC patients. METHODS: We included 196 patients with confirmed Helicobacter pylori infection by rapid urease test during screening endoscopy for health check-up from January 2016 to September 2016; all patients underwent blood tests for pepsinogen I and II and fasting serum gastrin. We compared RHG findings with various other endoscopic mucosal images. We also evaluated the relationships between RHG and other mucosal aspects for a given acid status based on serological markers. RESULTS: Hypoacid and ultra-low-acid (67%) statuses were dominant, with only 18% hyperacid patients. RHG with high acid was related to a less atrophic body type (p=0.001), and RHG with ultra-low acid was associated with body xanthoma (p=0.029) and increased serum gastrin level (p=0.038). However, RHG's influence on gastric acidity was only seen in closed-type endoscopic atrophic border (EAB), not in open type (p=0.001). CONCLUSION: The majority of RHG patients had hypoacid status. RHG frequency showed no difference between closed and opentype EAB, but gastric acidity was influenced by RHG only in closed-type EAB.

Assessment of Gastric Acidity by Conventional Endoscopy With Serological Gastric Markers.

BACKGROUND: Gastric acidity could determine Helicobacter pylori (H. pylori)-associated gastritis patterns. In reverse, H. pylori infection could lead disturbance in gastric acid secretion. We attempted to elucidate gastric acid status by conventional endoscopy with pepsinogen test. METHODS: A total of 196 subjects who visited our health promotion center were consecutively enrolled and evaluated by conventional endoscopy, and blood examinations with pepsinogen I, II, and fasting serum gastrin were conducted. As a Japanese study suggested that in H. pylori-positive subjects the cutoff value was PG I/II ratio ≤ 2.7 for hypochlorhydia, PG I/II ratio ≥ 3.3 for hyperchlorhydria. Based on these serological data, we compared conventional endoscopic images with each acid level. RESULTS: It showed that for hypoacidity, older age, and most of the H. pylori-associated endoscopic appearances featuring mucosal inflammation and more atrophy of corpus or antrum were in favor of hypoacidity in closed type. Mucosal appearances showing severe corpus atrophy and remnant gastritis with advanced background atrophy determine hypoacidity in open type. For hyperacidity, mucosal appearances featuring intact mucosa and less severe atrophy were associated with hyperacid status. Male gender, antrum camouflage were also involved in hyperacidity. CONCLUSIONS: Conventional endoscopy with pepsinogen test could be useful in gastric acid assessment.

A gastrointestinal stromal tumor of the duodenum masquerading as a pancreatic head tumor.

Gastrointestinal stromal tumor (GIST) represents the most common kind of mesenchymal tumor that arises from the alimentary tract. GIST is currently defined as a gastrointestinal tract mesenchymal tumor showing CD117 (c-kit protein) positivity at immunohistochemistry. Throughout the whole length of the gastrointestinal tract, GIST arises most commonly from the stomach followed by the small intestine, the colorectum, and the esophagus. Only 3%-5% of GISTs occur in the duodenum, and especially, if GIST arises from the C loop of the duodenum, it can be difficult to differentiate from the pancreas head mass because of its anatomical proximity. Here, we report a case of duodenal GIST, which was assessed as a pancreatic head tumor preoperatively.

Clinical significance of hepatitis B e antigen level measurement during long-term lamivudine therapy in chronic hepatitis B patients with e antigen positive.

AIM: To determine the changes of quantitative hepatitis B e antigen (HBeAg) that predicts early detection of non-response or breakthrough to long-term lamivudine (LAM) therapy. METHODS: Among HBeAg positive chronic hepatitis B patients who failed to achieve HBeAg seroconversion within 12 mo, we retrospectively analyzed 220 patients who had received LAM more than 24 mo. RESULTS: The mean duration of LAM therapy was 36 (range, 24-72) mo. HBeAg seroconversion after the first 12 mo of LAM therapy was achieved in 53 (24.1%) patients. Viral breakthrough was observed in 105 (47.7%) patients. To find out whether the changing patterns of HBeAg levels can predict the outcome of LAM therapy, we analyzed the reduction rates of HBeAg levels during LAM therapy. Using the decrease more than 90% of pretreatment HBeAg levels, the sensitivity and specificity of response were 96.2% and 70.1%, respectively. Patients were divided into 3 groups according to the reduction patterns of the decrease of quantitative HBeAg: decrescendo, decrescendo-crescendo, no change or fluctuating groups. The optimal time to predict non-response or breakthrough was the first 9 mo of therapy. At 9 mo of therapy, 49 (92.5%) of 53 patients who had achieved HBeAg seroconversion were included in the decrescendo group. On the contrary, in the no change or fluctuating group, only four (7.5%) had achieved HBeAg seroconversion. Among patients who did not show the continuous decrease of HBeAg levels at 9 mo, 95.2% (negative predictive value) failed to achieve HBeAg seroconversion. CONCLUSION: Almost all patients who failed to show a continuous decrease of HBeAg levels at 9 mo of LAM therapy were non-response or breakthrough. Therefore, monitoring changes of HBeAg levels during LAM therapy in HBeAg positive chronic hepatitis B may be valuable for identifying patients who are at high risk of non-response or breakthrough.