Randomised clinical trial: efficacy of the addition of a prokinetic, mosapride citrate, to omeprazole in the treatment of patients with non-erosive reflux disease - a double-blind, placebo-controlled study.

BACKGROUND: Proton pump inhibitors (PPIs) are less effective in non-erosive reflux disease (NERD) patients than in reflux oesophagitis patients. Whether the addition of prokinetics to PPIs improves NERD patients' symptoms remains unknown. AIM: To evaluate the efficacy of mosapride in NERD patients when used with PPI. METHODS: A total of 200 NERD patients were randomised to one of two arms: omeprazole (10 mg once daily) plus mosapride citrate (5 mg three times a day) (treatment arm) and omeprazole plus placebo (placebo arm). The primary endpoint was the rate of responders [visual analogue scale (VAS) was zero or <1 cm] after 4 weeks of treatment. The secondary endpoints were changes in the VAS score and the safety profile. RESULTS: There was no significant difference between the rates of responders in both arms in intent-to-treat (ITT) and per-protocol (PP) analysis. The change in the VAS score in treatment arm was significantly better than placebo arm in PP analysis (-4.0 ± 0.2 and -3.3 ± 0.2, mean ± S.E.M.) (N.S. in ITT analysis). The rate of adverse events was similar in both groups. CONCLUSION: The addition of mosapride to omeprazole was not more effective than omeprazole alone.

Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M: a validation study in a cohort of Japanese endoscopists.

The Los Angeles classification system is the most widely employed criteria associated with the greatest interobserver agreement among endoscopists. In Japan, the Los Angeles classification system has been modified (modified LA system) to include minimal changes as a distinct grade of reflux esophagitis, rather than as auxiliary findings. This adds a further grading M defined as minimal changes to the mucosa, such as erythema and/or whitish turbidity. The modified LA system has come to be used widely in Japan. However, there have been few reports to date that have evaluated the interobserver agreement in diagnosis when using the modified LA classification system incorporating these minimal changes as an additional grade. A total of 100 endoscopists from university hospitals and community hospitals, as well as private practices in the Osaka-Kobe area participated in the study. A total of 30 video clips of 30-40 seconds duration, mostly showing the esophagocardiac junction, were created and shown to 100 endoscopists using a video projector. The participating endoscopists completed a questionnaire regarding their clinical experience and rated the reflux esophagitis as shown in the video clips using the modified LA classification system. Agreement was assessed employing kappa (kappa) statistics for multiple raters. The kappa-value for all 91 endoscopists was 0.094, with a standard error of 0.002, indicating poor interobserver agreement. The endoscopists showed the best agreement on diagnosing grade A esophagitis (0.167), and the poorest agreement when diagnosing grade M esophagitis (0.033). The kappa-values for the diagnoses of grades N, M, and A esophagitis on identical video pairs were 0.275-0.315, with a standard error of 0.083-0.091, indicating fair intraobserver reproducibility among the endoscopists. The study results consistently indicate poor agreement regarding diagnoses as well as fair reproducibility of these diagnoses by endoscopists using the modified LA classification system, regardless of age, type of practice, past endoscopic experience, or current workload. However, grade M reflux esophagitis may not necessarily be irrelevant, as it may suggest an early form of reflux disease or an entirely new form of reflux esophagitis. Further research is required to elucidate the pathophysiological basis of minimal change esophagitis.

Prise en charge des cancers naso-sinusiens dans le service d'ORL du CHU de Treicheville (Abidjan)

Introduction : Les cancers des cavites naso-sinusiennes sont peu frequents et se singularisent par leurs varietes histologiques. Les objectifs de ce travail etaient de decrire les caracteristiques epidemiologiques et diagnostiques des cancers des cavites naso-sinusiennes; et d'evaluer leur traitement. Patients et methodes : Cette etude a concerne 8 patients (6 hommes et 2 femmes) operes pour un cancer des cavites naso-sinusiennes durant la periode allant du Ier janvier 1996 a 31 mai 2007. Resultats : Ils avaient un age moyen de 51 ans avec des extremes allant de 28 a 75 ans. Aucun facteur favorisant significatif n'a ete releve. Le diagnostic a ete tardif pour la plupart des cas (T2 : n=5). La voie de rhinotomie paralateronasale a ete utilisee pour l'exerese tumorale associee a un curage ganglionnaire dans un cas. Les suites operatoires ont ete marquees par des troubles neurologiques et oculaires. Trois cas de recidive ont ete observes. Le suivi post operatoire n'ayant pas excede trois mois; l'evolution a long terme et la mortalite n'ont pu etre evaluees. Conclusion : Dans notre service; les caracteristiques epidemiologiques et histologiques des cancers naso-sinusiens ont ete superposables a celles de la litterature. Le traitement essentiellement chirurgical a ete tardif et decevant

Le decollement premature du placenta normalement insere pronostic foeto-maternel: a propos de 1062 cas colleges a la clinique obstetricale du CHU de Treichville

Cette etude est retrospective et porte sur 1062 cas de decollement premature du placenta normalement insere recenses en 18 ans. Elle a permis de faire les constatations suivantes: frequence = 0;93 per cent; cet accident survient chez les femmes agees; grandes multipares de conditions socio-economiques mauvaises ayant neglige les consultations prenatales et connues hypertendues; la symptomatologie est en general grave dans 72;68 per cent des cas; le pronostic maternel est domine par: - le choc hypovolemique: 59;69 per cent - la coagulopathie: 24;10 per cent - l'oligo anurie: 13;93 per cent - l'hysterectomie en urgence: 0;75 per cent - la frequence des cesariennes: 80; 68 per cent - le deces maternel: 03;29 per cent; le pronostic foetal est domine par les deces foetaux dans 82; 81 per cent