Gastric Electrical Stimulation Improves Symptoms of Diabetic Gastroparesis in Patients on Peritoneal Dialysis-2 Case Reports.

Diabetic gastroparesis (DGP), a delay in gastric emptying without obstruction to outflow as a complication of diabetes, typically develops after at least 10 years of diabetes. Cardinal symptoms include nausea, vomiting, early satiety, bloating, and upper abdominal pain. The aim of DGP treatment is to alleviate the severity and frequency of symptoms, improve the level of gastric emptying, ameliorate the patient's nutritional status and to optimize glycemic control. In the treatment of chronic drug-refractory nausea and vomiting secondary to DGP, gastric electrical stimulation (GES) such as Enterra Therapy System (Medtronic Inc., Minneapolis, MN, USA) can be considered. It is well established that diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) requiring renal replacement therapy. The exact prevalence of patients with severe DGP and ESRD is not known; however, finding a therapeutic approach to these patients, particularly those whose gastroparesis symptoms preclude them from undergoing kidney transplant procedure, represents a huge challenge. Our experience suggests that GES implantation can be an effective treatment modality for type 1 diabetic patients on peritoneal dialysis (PD) who are simultaneous pancreas-kidney transplantation candidates, by improving the severity and frequency of gastroparesis symptoms and eventually ensuring their optimal nutritional and fluid intake.

Comparative Study of Intragastric Balloon and Cognitive-Behavioral Approach for Non-Morbid Obesity.

BACKGROUND/AIMS: Intragastric balloon (IGB) and cognitive-behavioral therapy (CBT) are possible options for weight reduction. The aim of our study was to compare their effectivness in inducing weight loss and metabolic changes accompanying weight loss in non-morbidly obese patients. METHODOLOGY: Subjects were required to be between 18 and 55 years old and to have a BMI between 30 and 45 to be eligible. Exclusion criteria, besides those for IGB placement, were the presence of diabetes, depression, binge-eating disorder and the use of medications that affect body weight. Anthropometric, biochemical and blood pressure measurements were performed at baseline and after 6 months. A total of 114 subjects were recruited to the study and assigned to IGB (n = 60) or CBT group (n = 54). All patients completed the study. RESULTS: After 6 months, patients treated with IGB lost significantly (P < 0.01) more weight (%EWL = 44.6 ± 23.9) than patients who participated in CBT (%EWL = 24.3 ± 16.0). In IGB group 75% of patients achieved ≥ 10% loss of initial weight, and 42.6% of patients in CBT group respectively. A significant improvement in all indices of metabolic syndrome except HDL cholesterol was seen in both treatment groups but much more in subjects treated with IGB. CONCLUSIONS: Our results confirmed that intragastric balloon is useful method for promoting weight loss. Due to improvement of metabolic parameters and substantial benefit on liver function, obese people with metabolic syndrome appear to be the best candidates for IGB placement. Combining intragastric balloon treatment with cognitive-behavioral approach might prove valuable for even greater weight loss.

Cannabis-induced acute pancreatitis.

Acute pancreatitis is a common disease. Despite the frequent use of cannabis worldwide, only six reports have described cases of acute pancreatitis secondary to the use of tetrahydrocannabinoid (THC). Here we describe two cases of THC-induced pancreatitis. The first case occurred in a 38-year-old man with multiple admissions for THC-induced pancreatitis; the second case involved a 22-year-old man with no previous medical history. In both cases, other possible causes of acute pancreatitis were ruled out.

CTLA-4 +49 and TNF-alpha-308 gene polymorphisms in celiac patients with exocrine pancreatic insufficiency.

Celiac disease (CD) is a life-long gluten sensitive autoimmune disease of the small intestine affecting genetically susceptible individuals. Human leukocyte antigen (HLA) genotype contributes to the genetic risk for CD, but "non-HLA" genes also play a role. Clinical presentation could be classical, but majority of patients present with non-classical, atypical signs and symptoms. Endocrine and/or exocrine pancreatic insufficiency (EXPI) is common in celiac patients. The aim of our study was to assess EXPI among our CD patients by measurement of faecal pancreatic elastase (FE1) and to find potential association of CTLA-4 +49 and TNF-alpha-308 gene polymorphism and EXPI. Eighty three patients entered the study. Tissue transglutaminase antibodies (anti-TTG), faecal elastase-1 (FE1) assays and genotyping for the CTLA-4 +49A/G and TNF-alpha308 were performed. Of 83 patients with CD EXPI had 13 (15.6 %). There was no statistically significant difference in frequency of polymorphisms for both genes (CTL-4 +49 i TNF-alpha-308) in the group with and without EXPI. In conclusion, EXPI is common in symptomatic CD patients, but further genetic studies with larger number of patients are needed.

Comparison of three postoperative follow-up methods in patients with oral cancer.

The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 286 patients surgically treated for oral and pharyngeal cancer in period from 1991 to 2007 at three different institutions, divided into three groups based on the different postoperative follow up protocol. In this study we were able to show that the period of identification of recurrences and neck metastases was significantly shorter in the group of patients whose follow up included neck ultrasound, along with methods of inspection and palpation of the oral cavity and the neck. In conclusion, implementation of more contemporary methods such as the neck ultrasound is needed along with usual follow up methods, such as inspection and palpation of the oral cavity and the neck. Also, follow up of the patients surgically treated for the oral cavity cancer should be conducted systematically. Ultrasound examination of the neck should be recommended due to its low cost, harmlessness, possible frequent usage, high quality visual imaging and possibility of combination with the fine needle aspiration cytology (FNAC) of the suspicious lymph nodes.

Intragastric balloon treatment for obesity: results of a large single center prospective study.

BACKGROUND: The intragastric balloon is a widely used method in the treatment of obesity indicated for those patients who have failed to achieve and maintain the weight loss with conventional measures or for preparation of patients who are candidates for bariatric surgery. METHODS: From April 2007 to April 2009, 171 consecutive patients (111 females, 60 males; mean age 39.2 ± 10.5, mean weight 123.2 ± 27.1 kg) were evaluated before and 6 months after bioenteric intragastric balloon (BIB) placement by assessment of anthropometric and biochemical parameters. RESULTS: The mean BMI during balloon treatment declined from 41.9 ± 7.3 to 36.0 ± 7.9 kg/m² (p < 0.001) with a percentage of excess weight loss of 39.7 ± 23.6 and percentage of excess body mass index loss of 39.5 ± 25.1. A significant improvement in blood pressure, glycemia, and triglyceride level but not in total cholesterol, high-density lipoprotein, and low-density lipoprotein cholesterol levels was seen. CONCLUSION: Results of this large prospective single center study confirmed that intragastric balloon is useful and safe method for promoting weight loss. Due to improvement of metabolic parameters, treatment with BIB results in reduction of cardiovascular risk and provides a sustained benefit on liver function in obese patients.

How activity of inflammatory bowel disease influences bone loss.

Bone loss is a common problem for individuals with inflammatory bowel disease (IBD). The aim of our study was to assess bone mineral density (BMD) in patients with IBD and to investigate the role of corticosteroid (CS) use and duration and activity of disease on BMD. Ninety-two patients (56 men and 36 women) with IBD, of whom 32 had ulcerative colitis (UC) and 60 had Crohn's disease (CD), underwent clinical assessment. Lumbar and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. Osteopenia was observed in 14 patients (43%) with UC and in 24 patients (40%) with CD (p=0.187). Four patients (12%) with UC and 7 patients (11%) with CD had osteoporosis (p=0.308). Femoral BMD decreased in patients with long duration of CS use and correlated inversely with disease activity. Multiple regression analysis of BMD showed that statistically significant risk factors were duration of active disease and body mass index as well. Based on our results, it is necessary to take into account the risk of decreased BMD in patients with IBD. It is most important to achieve disease remission as soon as possible in addition to nutritional support.

Pyostomatitis vegetans associated with inflammatory bowel disease--report of two cases.

Pyostomatitis vegetans (PV) is a rare, chronic mucocutaneous disorder associated with inflammatory bowel disease (IBD). Oral lesions of PV are distinct and present as multiple white or yellow pustules with an erythematous base that coalesce and undergo necrosis to form a typical "snail tracks" appearance. Two cases of PV associated with IBD--one with Crohn's disease (CD) and the other with ulcerative colitis (UC) are reported. In the first case, adalimumab therapy brought the oral and gastrointestinal manifestations to complete remission. In the second case, the remission was achieved with systemic steroid therapy, but the disease relapsed after therapy discontinuation. Azathioprine was added leading to sustained remission of PV. Because of persistent active intestinal manifestation of UC, in spite of immunosuppressive therapy, infliximab was introduced. With the therapy remission of intestinal manifestation of UC was achieved as well. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of oral lesions.

Prognostic significance of vascular endothelial growth factor expression in clear cell renal cell carcinoma.

The purpose of this investigation was to analyze and correlate the immunohistochemical pattern of vascular endothelial growth factor (VEGF) expression with the average of microvessel density (MVD) and other clinicopathologic parameters in clear cell renal cell carcinoma (CCRCC) in order to determine its prognostic significance. Surgical specimens of 93 CCRCC were immunohistochemically analyzed for VEGF expression, MVD with anti-CD31, and Ki 67 proliferative index. VEGF expression was recorded as the percentage of positive tumor cells (<75% and >75%) and as diffuse or perimembranous VEGF expression according to cytoplasmic distribution. Sixty-three (68%) RCC had <75% and 30 had (32%) >75% of VEGF expression. A diffuse cytoplasmic pattern of VEGF expression was found in 61(66%) RCC and a perimembranous one in 32 (34%) RCC. Statistical analysis showed that tumors with >75% of VEGF expression were characterized by lower MVD value (p=0.034), higher nuclear grade (p=0.018), and higher Ki 67 proliferation index (p=0.023). Moreover, a higher nuclear grade of tumor cells was characterized by diffuse cytoplasmic VEGF distribution (p=0.005). This tumor model did not confirm the postulated simple relationship between VEGF overexpression and angiogenesis through high microvessel count. However, the study results indicated that overexpression of VEGF was a worse histologic prognostic parameter in CCRCC.