Combined treatment of achalasia - botulinum toxin injection followed by pneumatic dilatation: long-term results.

Injection of botulinum toxin (BT) and pneumatic dilatation are available methods in nonsurgical treatment of achalasia. Authors anticipate beneficial effect of prior BT injection on the success of pneumatic dilatation and duration of its effect. There are no long-term data available to assess efficacy of combined treatment. From 1998 to 2007, 51 consecutive patients (20 men and 31 women, age 24-83) with achalasia were included and prospectively followed up. Each patient received injection of 200 IU of BT into the lower esophageal sphincter (LES) during endoscopy and 8 days later pneumatic dilatation (PD) under X-ray control was performed. The follow-up was established every 3 months first year and then annually. The efficacy was evaluated by a questionnaire concerning patient's symptoms and manometry. Results were compared with 40 historical controls (16 men and 24 women, age 26-80) treated by PD alone using the same method and follow-up. Fifty-one patients underwent combined treatment. Four patients failed in follow-up and were not included for analysis. The mean duration of follow-up was 48 months with range 12-96 months. Thirty-four of forty-seven (72%) patients were satisfied with results with none or very rare and mild troubles at the time of the last visit. Forty-one patients were followed up more than 2 years. Effect of therapy lasted in 75% (31/41) of them. In 17 patients, more than 5 years after treatment, effect lasted in 12 (70%). Mean tonus of LES before therapy was 29 mm Hg (10-80), 3 months after therapy decreased to 14 mmHg (5-26). The cumulative 5 years remission rate (+/-95% CI) in combined treated patients 69% +/- 8% was higher than in controls 50% +/- 9%; however it, was not statistically significant (P= 0.07). In control group 1, case of perforation (2.5%) occurred. Eight patients (17%) with relapse of dysphagia were referred to laparoscopic Heller myotomy with no surgical complication. The main adverse effect was heartburn that appeared in 17 patients (36%). Initial injection of BT followed by PD seems to be effective for long-term results with fewer complications. But the combined therapy is not significantly superior to PD alone.

[Metal stents in patients with malignant and benign esophageal stenoses]. / Kovové stenty u nemocných s maligní a benigní stenózou jícnu.

The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

[Abdominal pain in childhood caused by stenosis of the pyelo-ureteral junction]. / Bolesti brucha v detskom veku spôsobené stenózou pyeloureterálnej junkcie.

The authors describe three patients with episodes of abdominal pain where despite a negative finding in the urine sonography revealed dilatation of the hollow system. Urography proved stenosis of the pyeloureteral junction. The authors discuss the cause of abdominal pain. Consistent with data in the literature, the authors draw attention to pitfalls in the diagnosis of hydronephrosis. They recommend sonographic examination of children with abdominal pain, as a negative urinary finding does not rule out hydronephrosis. In this respect screening of hydronephrosis and other obstructive anomalies during the neonatal period is an advantage.

[Mechanisms of the effect of allopurinol on the metabolism of adenine nucleotides]. / Mechanizmy pôsobenia alopurinolu na metabolizmus adenínových nukleotidov.

The effect of repeated administration of allopurinol (50 mg.kg-1 48, 24, and 4 hours before analysis) on the activity of enzymes of degradation and resynthesis of adenine nucleotides was studied. The activity of xanthine dehydrogenase and xanthine oxidase was inhibited in the heart, liver and kidney and the activity of membrane-bound 5'-nucleotidase was particularly elevated in the heart and brain, suggesting that membrane transport processes may be affected. The increase in the activity of hypoxanthine guanine phosphoribosyl transferase in the liver is indicative of a potential mechanism of positive action of allopurinol upon restoring the purine nucleotide store. The authors present their hypothesis on the mechanism of allopurinol action upon the metabolism of adenine nucleotides. The suggested mechanisms might become operative in protecting tissues against ischemia and reperfusion induced damage.

[Long-term ECG monitoring (Holter) in a group of healthy 14-to-18-year-old adolescents]. / Dlhodobé sledovanie EKG (Holter) v súbore zdravých mladistvých vo veku 14-18 rokov.

Using 24-hour Holter ECG examinations, the authors assessed ECG changes in a group of 86 healthy students of a Bratislava secondary school. The students were 14-18 years old. Their mean age was 15.8 years. As to ECG changes, the authors evaluated changes of the heart rate, ectopic disorders of the cardiac rhythm and right bundle branch block. Almost in all students the authors detected one or several disorders of the heart rhythm. Extreme changes were recorded in particular in the heart rate, i. e. tachycardia and bradycardia. Sinus arrhythmia was present in 80.2% of the adolescents, right bundle branch block in 57%, and as to ectopic disorders, ventricular extrasystoles were present in 51.2% of the students and supraventricular ones in 34.9%.