Allergist RSS : Gourt

Pediatric AI, University of New Mexico, #1 Place for Business and Careers by Forbes, #5278 :: New Mexico :: Timeline Recruiting

Nestled against the Sandia Mountains, Albuquerque is a dream destination. Impossible to avoid our incredible scenery, we offer four beautiful seasons with that Southwestern backdrop we are famous

Allergy opportunity in North Carolina close to the Atlantic Ocean :: North Carolina :: CompHealth Inc

Job 9110905 Assume a waiting Allergy patient base in North Carolina Stable multi specialty group seeks a Board Certified / Eligible Allergy Doctor Assume a waiting patient base. Be busy from day one!

Excellent Allergy/Immunology Opportunity in Washington State :: Washington :: CompHealth Inc

Job 514776 Join a highly respected organization located in this beautiful part of Washington Receive excellent competitive base income Earning potential is huge and exciting Wonderful, desirable and

Allergist Job Opportunity for Locum Tenens in Tennessee! :: North Carolina :: CompHealth Inc

Job 1166857-0001 We have an immediate opening for a Board Certified Allergist. This could easily work in to a permanent job opportunity. Please contact our Physician Recruiter for full details. Thank

Excellent opportunity for Allergist in Pennsylvania :: Pennsylvania :: Weatherby Locums

Job 9612060-0001 Group practice seeks locums Allergy physician to provide on-going coverage beginning as soon as possible. Ideal candidate will be eligible for licensure. Inpatient / Outpatient Great,

Oklahoma College town needs an Allergy and Immunol :: Oklahoma :: Enterprise Medical Service

Multi-specialty group in Muskogee, Oklahoma looking to add a BC/BE Allergist and Immunologist-Job #16506 due to growth and retirement. This clinic offers the highest quality medical care to the citizens

Allergy Opportunity in North Dakota :: North Dakota :: CompHealth Inc

Job 918660 Large Midwestern MSG is seeking an Allergy Doctor to join their practice High volume practice Be busy from day one Large service area Enjoy crystal blue lakes Low cost of living Family friendly

Massachusetts Locums Allergist :: Massachusetts :: CompHealth Inc

Job 1728017-0001 Client is in need of vacation coverage. Call for dates... 100% Outpatient. Candidate will not have to get hospital privileges Caseload: One third of patient load is Pediatric and two

Group seeks Allergist :: New York :: CompHealth Inc

Job 9111009 Join dept. of 1 who retires in 2010 B/C or B/E Allergy Multispecialty group provides referrals Join 1 established who will retire Support of Allergy trained RN Great schools, safe friendly

Call for information :: South Carolina :: Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

Fargo - Moorhead :: North Dakota :: Job Job Recruiting

Join Prestigious Upper Midwest Medical Group Excellent practice opportunity for BC/BE Allergist/Immunologist. Practice full-spectrum of allergy/immunology. Teaching opportunity available through the

South Central :: Kansas :: Rural Health Education & Services

KRC.1009.0813.04 BC/BE certified Allergy and Immunologist needed for a 65 physician multispecialty group. This well-established group is located conveniently near the admitting 200-bed hospital. This

Not Disclosed :: North Carolina :: Locum Medical Group

A facility along the North Carolina coast is looking for permanent physician in the specialty of Allergy and Immunology. This position can start ASAP. Ideal candidates will complete a residency in IM,

Ft. Belvoir :: Virginia :: Absolute Staffers

Allergist Needed For Army Community Hospital in Northern VA Great Salary + Great Atmosphere + Great Opportunity Living in Northern Virginia Northern Virginia is rich with history and beautiful scenery.

Grand Forks :: North Dakota :: Job Job Recruiting

Well established practice with built in referral Our Health System has an opportunity for BC/BE Allergist/Immunologist to join our practice in Grand Forks , ND. Join a well established practice with

Derry :: New Hampshire :: New England Physician Recruitment Center

Southern NH -40 minutes to Boston Established Medical Facility in Southern New Hampshire seeking Allergy Specialist. Providing exceptional Primary Care services for over 10 years, this group offers multiple

Reduced Immunoglobulin M Is Associated with Sinus Mucosal Thickening, Osteitis and Sinus Surgery in Patients with Common Variable Immunodeficiency

Int Arch Allergy Immunol 2010;152:81-86 (DOI:10.1159/000260088)

Differential Mucosal IL-17 Expression in Two Gliadin-Induced Disorders: Gluten Sensitivity and the Autoimmune Enteropathy Celiac Disease

Int Arch Allergy Immunol 2010;152:75-80 (DOI:10.1159/000260087)

Xolair Is Effective in Allergics with a Low Serum IgE Level

Int Arch Allergy Immunol 2010;152:71-74 (DOI:10.1159/000260086)

Serum Transforming Growth Factor-b Levels Depend on Allergen Exposure in Allergic Rhinitis

Int Arch Allergy Immunol 2010;152:66-70 (DOI:10.1159/000260085)

Occupational Allergy in Strawberry Greenhouse Workers

Int Arch Allergy Immunol 2010;152:58-65 (DOI:10.1159/000260084)

Airborne Study of Grass Allergen (Lol p 1) in Different-Sized Particles

Int Arch Allergy Immunol 2010;152:49-57 (DOI:10.1159/000260083)

Sublingual Immunotherapy Efficacy of Dermatophagoides farinae Vaccine in a Murine Asthma Model

Int Arch Allergy Immunol 2010;152:41-48 (DOI:10.1159/000260082)

A Six-SNP Haplotype of ADAM33 Is Associated with Asthma in a Population of Cartagena, Colombia

Int Arch Allergy Immunol 2010;152:32-40 (DOI:10.1159/000260081)

Tryptase Is Not Cleared by the Kidneys into the Urine

Int Arch Allergy Immunol 2010;152:28-31 (DOI:10.1159/000260080)

Localization of DNA and RNA in Eosinophil Secretory Granules

Int Arch Allergy Immunol 2010;152:12-27 (DOI:10.1159/000260079)

Relevant B Cell Epitopes in Allergic Disease

Int Arch Allergy Immunol 2010;152:1-11 (DOI:10.1159/000260078)

Contents Vol. 150, 2009

Int Arch Allergy Immunol 2009;150:I-IV (DOI:10.1159/000259905)

Subject Index Vol. 150, 2009

Int Arch Allergy Immunol 2009;150:401-402 (DOI:10.1159/000259904)

Author Index Vol. 150, 2009

Int Arch Allergy Immunol 2009;150:398-400 (DOI:10.1159/000259903)

Erratum

Int Arch Allergy Immunol 2009;150:342 (DOI:10.1159/000255392)

The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests

Int Arch Allergy Immunol 2010;151:343-345 (DOI:10.1159/000250443)

Prevalence of Food Allergy among Children in Al-Ain City, United Arab Emirates

Int Arch Allergy Immunol 2010;151:336-342 (DOI:10.1159/000250442)

Oral Challenge with Pasteurized Egg White from Gallus domesticus

Int Arch Allergy Immunol 2010;151:331-335 (DOI:10.1159/000250441)

Antiapoptotic Seminal Vesicle Protein IV Induces Histamine Release from Human FceRI+ Cells

Int Arch Allergy Immunol 2010;151:318-330 (DOI:10.1159/000250440)

Galectin-9 in Allergic Airway Inflammation and Hyper-Responsiveness in Mice

Int Arch Allergy Immunol 2010;151:308-317 (DOI:10.1159/000250439)

On the Cover

Smoking cessation toolbox for allergists

The atopic march: what's the evidence?

Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis

Decrease in airway mucous gene expression caused by treatment with anti-tumor necrosis factor in a murine model of allergic asthma

Differences in physicians self-reported knowledge of, attitudes toward, and responses to the black box warning on long-acting -agonists

Factors associated with severity and exacerbation of asthma: a baseline analysis of the COhort for Reality and Evolution of adult Asthma in Korea (COREA)

Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma

Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma

High sensitization rate to food allergens in breastfed infants with atopic dermatitis

Influence of dose and frequency of antigen injection on IgE development in young children: a comparison of fire ant stings and tetanus immunizations

Differences in total and allergen specific IgE during pregnancy compared with 1 month and 1 year post partum

Bromotyrosines in sputum proteins and treatment effects of terbutaline and budesonide in asthma

UNUSUAL COMPLICATION WITH USE OF AN INSTANT COLD PACK

USE OF EPINEPHRINE AUTOINJECTORS FOR TREATMENT OF ANAPHYLAXIS: WHICH COMMERCIALLY AVAILABLE AUTOINJECTOR DO PATIENTS PREFER?

REGULATION OF MONOCYTE CHEMOATTRACTANT PROTEIN 1 BY CYSTEINYL LEUKOTRIENE D4 IN HUMAN LUNG EPITHELIAL A549 CELLS

SEVERE ANAPHYLACTOID SHOCK SECONDARY TO GADOLINIUM CONTRAST MEDIA

Gastroesophageal reflux-associated aspiration alters the immune response in asthma

Abstract Background A large number of studies point toward chronic aspiration associated with gastroesophageal reflux disease (GERD) as an important factor involved in the development of asthma, the incidence of which has increased dramatically in industrially developed countries. Recent work suggests that medical intervention aimed at acid blockade is not sufficient to relieve the effects of chronic aspiration on asthma pathology, leaving surgical treatment of the disease as one of the few remaining options. This study examined the effect of chronic aspiration on the airway-associated immune response to allergens using a model of experimentally induced airway hypersensitivity in Balb/c mice. Methods The mice received aspiration of gastric fluid on days 1, 8, 15, 22, 29, 36, 43, and 50 and were sensitized to ovalbumin by intraperitoneal (IP) injection on days 33 and 47, challenged with aerosolized ovalbumin on day 54, and killed on day 56. Control mice received sham gastric fluid aspirations, sham induction of airway hypersensitivity, or both. Results Chronic aspiration of 50 μl murine gastric fluid once per week for 8 weeks had a profound effect on the immune system in the lung, with upregulation of the macrophage/monocyte-associated cytokines tumor necrosis factor-α (TNF-α) and interleukin-12 (IL-12) and profound downregulation of a broad array of T-cell-associated cytokines including interleukins 2, 4, 5, 6, 10, 13, and 23, as well as interferon-γ. The aspiration-induced depression of IL-5 production in particular was found only in mice with airway hypersensitivity and not in control mice without airway hypersensitivity. Conclusions The results indicate that chronic aspiration of gastric fluid has a profound effect on the nature of the allergic response to aerosolized allergens, suggesting that the aspiration may be an important factor affecting the pathogenesis of asthma. Content Type Journal ArticleDOI 10.1007/s00464-009-0727-5Authors Anitra D. Thomas, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAKuei-Ying Su, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAJui-Chih Chang, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAJason H. Leung, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USASean M. Lee, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAZoie E. Holzknecht, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAMary Lou Everett, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAWilliam Parker, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAR. Duane Davis, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USAShu S. Lin, Duke University Medical Center Department of Surgery DUMC Box 2605 Durham NC 27710 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Optimizing lymphadenectomy in laparoscopic surgery for colon cancer

Optimizing lymphadenectomy in laparoscopic surgery for colon cancer Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0747-1Authors Christof Hottenrott, Chirurgische Klinik St. Elisabethenkrankenhaus Frankfurt Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Internal validity of randomized controlled trials reported in major gastrointestinal and surgical endoscopy journals in 2008

Abstract Background Assessment of the reported methodology for randomized controlled trials (RCTs) in the major gastrointestinal and surgical endoscopy journals has never been reported. Methods Generation of the allocation sequence, allocation concealment, double blinding, sample size calculation, number of patients, and funding source included in methodologic quality were retrieved from each trial, and all the relevant trials were identified by a search of all clinical trials published in 2008 in four major gastrointestinal and surgical endoscopy journals. Results A total of 64 trials were included in the final analysis, which found that 50% (32/64) of all trials reported adequate generation of the allocation sequence, 58% (37/64) reported adequate allocation concealment, 47% (30/64) reported adequate blinding, 47% (30/64) reported adequate sample size calculation, and 67% (43/64) failed to disclose the funding source. Conclusions The study showed that the quality of the reported methodology in the major gastrointestinal and surgical endoscopy journals needs great improvement. Content Type Journal ArticleDOI 10.1007/s00464-009-0743-5Authors Yu Bai, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaYong-Fa Wu, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaDong Wang, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaYang Xia, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaJun Gao, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaDuo-Wu Zou, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai ChinaZhao-Shen Li, Changhai Hospital, Second Military Medical University Evidence-Based Medicine Group, Department of Gastroenterology 168 Changhai Road Shanghai China Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation?

Abstract Background Colonic perforation is an uncommon but serious colonoscopy-associated complication. This study assessed the effectiveness of conservative management with endoscopic clipping for colonoscopy-associated perforations. Methods Clinical manifestations and management outcomes were assessed for 38 patients with colonoscopy-associated colonic perforations that occurred between January 2001 and April 2008 at the Asan Medical Center, Seoul, Korea. These perforations were classified as endoscopically evident, endoscopically suspected, and radiologically proven. Results Of the 38 perforations, 19 were endoscopically evident, 9 were endoscopically suspected, and 10 were radiologically proven but without endoscopic evidence. Of the 19 patients with endoscopically evident perforations, 13 (68.4%) underwent endoscopic closure with clips, and all improved without surgery. All nine patients with endoscopically suspected perforations underwent endoscopic closure, and eight (88.9%) improved without surgery. Of the 10 radiologically proven perforations, 7 were detected within 1 day after colonoscopy. All the patients improved without surgery. However, two of the three patients with delayed perforations required emergency laparotomy. Consequently, of the 38 patients with perforations, 29 (76.3%) improved without surgery. Of the 28 patients with endoscopically evident or suspected perforations, conservative management was successful for 21 (95.5%) of the 22 patients with effective clipping, but for none (0%) of the 6 patients without clipping. Conclusions Conservative management by immediate endoscopic closure with clips can be effective for the treatment of colonic perforations detected during colonoscopy. Conservative management also may be tried cautiously for stable patients who have radiologically proven colonoscopy-associated perforations without endoscopic evidence. Content Type Journal ArticleDOI 10.1007/s00464-009-0746-2Authors Dong-Hoon Yang, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaJeong-Sik Byeon, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaKyung-Hoon Lee, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaSoon Man Yoon, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaKyung Jo Kim, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaByong Duk Ye, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaSeung-Jae Myung, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaSuk-Kyun Yang, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 KoreaJin-Ho Kim, University of Ulsan College of Medicine, Asan Medical Center Department of Internal Medicine 388-1, Pungnap-2dong, Songpa-gu Seoul 138-736 Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Objective classification of residents based on their psychomotor laparoscopic skills

Abstract Background From the clinical point of view, it is important to recognize residents’ level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as “experienced,” “intermediates,” or “novices” according to their technical abilities. This study introduces a classification method for recognizing residents’ level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone. Methods For this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10–100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out cross-validation. Results Of 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices. Conclusions The proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers. Content Type Journal ArticleDOI 10.1007/s00464-009-0721-yAuthors Magdalena K. Chmarra, Delft University of Technology Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE) Mekelweg 2 2628 CD Delft The NetherlandsStefan Klein, University Medical Center Utrecht Image Sciences Institute Utrecht The NetherlandsJoost C. F. de Winter, Delft University of Technology Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE) Mekelweg 2 2628 CD Delft The NetherlandsFrank-Willem Jansen, Delft University of Technology Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE) Mekelweg 2 2628 CD Delft The NetherlandsJenny Dankelman, Delft University of Technology Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE) Mekelweg 2 2628 CD Delft The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Appropriate management of common bile duct stones: A RAND Corporation/UCLA Appropriateness Method statistical analysis

Abstract Background Bile duct stones affect 10% of patients who undergo a cholecystectomy and therefore represent a major health problem. Laparoscopic common bile duct exploration, endoscopic sphincterotomy, and open surgical choledocholithotomy are the three available methods for dealing with choledocholithiasis. Though many trials and reviews have compared all three strategies, a list of indications for defined patient profiles is lacking. Methods We employed the RAND Corporation/UCLA Appropriateness Method (RAM) to evaluate the three procedures for bile duct stone clearance. An expert panel judged appropriateness after a comprehensive bibliography review, a first-round private rating of 108 different clinical situations, a consensus meeting, and a second round of definitive rating. A list of indications for each procedure was statistically calculated. Results A consensus was reached for 41 indications (38%). The endoscopic approach was always appropriate for preoperatively diagnosed bile duct stones and inappropriate for patients with single intraoperative detected stones causing cholangitis and bile duct dilatation. Laparoscopic bile duct exploration was appropriate for preoperatively diagnosed choledocholithiasis if patients had not undergone a previous cholecystectomy and no signs of cholangitis were detected. The laparoscopic approach was also appropriate for intraoperatively incidentally detected stones, except for septic patients with poor performance status and multiple calculi. Laparoscopic bile duct clearance was judged inappropriate for septic patients with poor performance status and absence of bile duct dilatation. Open surgery was appropriate in all patients with intraoperative diagnosis of choledocholithiasis and cholangitis and in septic patients with bile duct dilatation. There was no clinical situation in which open surgery was appropriate when bile duct stones were preoperatively diagnosed. Conclusions There is still uncertainty with respect to the management of choledocholithiasis, showing the need for further investigation. The RAM helps to elucidate appropriateness for the different treatment options in specific clinical settings. Content Type Journal ArticleDOI 10.1007/s00464-009-0748-0Authors Pablo Parra-Membrives, Valme University Hospital Hepato-bilio-pancreatic Surgery Unit of the General and Digestive Surgery Department Carretera de Cádiz s/n 41014 Sevilla SpainDaniel Díaz-Gómez, Valme University Hospital Hepato-bilio-pancreatic Surgery Unit of the General and Digestive Surgery Department Carretera de Cádiz s/n 41014 Sevilla SpainRomán Vilegas-Portero, The Emerging Technologies Observatory Andalusian Agency for Health Technology Assessment Sevilla SpainMáximo Molina-Linde, The Emerging Technologies Observatory Andalusian Agency for Health Technology Assessment Sevilla SpainLourdes Gómez-Bujedo, High Resolution Hospital Center of Utrera Sevilla SpainJuan Ramón Lacalle-Remigio, University of Seville Department of Preventive Medicine Sevilla Spain Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Endoscopic management of pancreatic pseudocysts at atypical locations

Abstract Background and aims There is paucity of data on endoscopic management of pseudocysts at atypical locations. We evaluated the efficacy of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of pseudocysts of pancreas at atypical locations. Patients and methods Eleven patients with pseudocysts at atypical locations were treated with attempted endoscopic transpapillary nasopancreatic drainage. On endoscopic retrograde pancreatography (ERP), a 5-F NPD was placed across/near the site of duct disruption. Results Three patients each had mediastinal, intrahepatic, and intra/perisplenic pseudocysts and one patient each had renal and pelvic pseudocyst. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. The size of the pseudocysts ranged from 2 to 15 cm. On ERP, the site of ductal disruption was in the body of pancreas in five patients (45.4%), and tail of pancreas in six patients (54.6%). All the patients had partial disruption of pancreatic duct. The NPD was successfully placed across the disruption in 10 of the 11 patients (90.9%) and pseudocysts resolved in 4–8 weeks. One of the patients developed fever, 5 days after the procedure, which was successfully treated by intravenous antibiotics. In another patient, NPD became blocked 12 days after the procedure and was successfully opened by aspiration. The NPD slipped out in one of the patient with splenic pseudocyst and was replaced with a stent. There was no recurrence of symptoms or pseudocysts during follow-up of 3–70 months. Conclusion Pancreatic pseudocysts at atypical locations with ductal communication and partial ductal disruption that is bridged by NPD can also be effectively treated with endoscopic transpapillary NPD placement. Content Type Journal ArticleDOI 10.1007/s00464-009-0732-8Authors Deepak Kumar Bhasin, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaSurinder Singh Rana, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaMohit Nanda, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaVijant Singh Chandail, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaIbrahim Masoodi, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaMandeep Kang, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Radiodiagnosis Sector 12 Chandigarh 160012 IndiaNavin Kalra, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Radiodiagnosis Sector 12 Chandigarh 160012 IndiaSaroj Kant Sinha, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaBirinder Nagi, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 IndiaKartar Singh, Post Graduate Institute of Medical Education and Research (PGIMER) Department of Gastroenterology Sector 12 Chandigarh 160012 India Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy

Abstract Background During laparoscopy, pneumoperitoneum may result in intraoperative atelectasis, which impairs normal gas exchange. This study investigated whether positive end-expiratory pressure (PEEP) of 5 cmH2O in pressure-controlled ventilation (PCV) mode can improve ventilatory and oxygenation parameters during pneumoperitoneum. Methods Thirty patients, aged 18–65 years, undergoing laparoscopic cholecystectomy were randomly allocated to the ZEEP (PEEP = 0 cmH2O) or PEEP (PEEP = 5 cmH2O) group. PCV was started after induction of anesthesia. Apart from PEEP level, all other ventilator settings were identical for both groups. Peak airway pressure was set at induction and reset after pneumoperitoneum to deliver tidal volume of 8 ml/kg in both groups. Hemodynamic, ventilatory, and oxygenation parameters were measured after induction of anesthesia (T1) and 30 min after pneumoperitoneum (T2). Results Oxygenation index (PaO2/FiO2) was significantly higher in the PEEP group than in the ZEEP group at T2 (P = 0.031). In both groups, dynamic compliance significantly decreased over 40 min from T1 to T2. There were no significant differences in hemodynamics between the two groups during the study period. Conclusion Application of PEEP of 5 cmH2O should be considered in PCV during laparoscopic surgeries to decrease intraoperative atelectasis caused by pneumoperitoneum to improve gas exchange and oxygenation. Content Type Journal ArticleDOI 10.1007/s00464-009-0734-6Authors Ji Young Kim, Yonsei University College of Medicine Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute Seoul KoreaCheung Soo Shin, Yonsei University College of Medicine Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute Seoul KoreaHong Soon Kim, Gachon University of Medicine and Science Gil Medical Center Department of Anesthesiology and Pain Medicine 1198 Guwol-dong, Namdong-gu Incheon 405-760 KoreaWol Sun Jung, Gachon University of Medicine and Science Gil Medical Center Department of Anesthesiology and Pain Medicine 1198 Guwol-dong, Namdong-gu Incheon 405-760 KoreaHyun Jeong Kwak, Gachon University of Medicine and Science Gil Medical Center Department of Anesthesiology and Pain Medicine 1198 Guwol-dong, Namdong-gu Incheon 405-760 Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Curability risks by endoscopic submucosal dissection for early gastric cancer

Curability risks by endoscopic submucosal dissection for early gastric cancer Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0749-zAuthors Christof Hottenrott, Chirurgische Klinik St. Elisabethenkrankenhaus Ginnheimer Straße 3 Frankfurt 60487 Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Our perception of “Women’s positive perception of transvaginal NOTES surgery”: Let the voices be heard, not just counted

Our perception of “Women’s positive perception of transvaginal NOTES surgery”: Let the voices be heard, not just counted Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0750-6Authors Francisco César Becerra Garcia, Universitätsklinikum Tübingen Sektion für Minimal Invasive Chirurgie Tübingen GermanyKarina Elizabeth Romo-Medrano Mora, Amsterdam University, Amsterdam University Masters Program in Medical Anthropology Faculty of Social and Behavioural Sciences Amsterdam The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Increased vascular endothelial growth factor transcription in residual hepatocellular carcinoma after open versus laparoscopic hepatectomy in a small animal model

Abstract Background Vascular endothelial growth factor (VEGF) is overexpressed in hepatocellular carcinoma (HCC), and findings have shown that its upregulation in these tumors has an impact on tumor growth. The authors hypothesized that compared with open liver resection, laparoscopic hepatectomy would result in a decreased local angiogenic response in residual tumor cells. Methods Right- and left-lobe hepatomas were induced in Buffalo rats via laparoscopically guided subcapsular injection of Morris hepatoma cells. After 1 week, the animals were randomized to laparoscopic or open left lateral hepatectomy. In 14 days after resection, the rats were killed, the residual right lobe tumors were measured, and tissue was procured for RNA extraction. Transcript levels of VEGF messenger RNA (mRNA) were quantified with reverse transcriptase-polymerase chain reaction (RT–PCR), and VEGF serum levels were measured by enzyme-linked immunoassay (ELISA) both before resection and at the time of tissue harvest. Results None of the animals had development satellite liver lesions or distant metastases in the abdomen or thorax. The median residual tumor volume was 320 mm3 in the open group compared with 180 mm3 in the laparoscopic group (p = 0.164). The animals that underwent open resection had a 1.3-fold increase in VEGF mRNA transcript levels compared with the laparoscopic resection group (p = 0.008). The serum VEGF levels were not significantly different between the laparoscopic and open groups at baseline (open tumor resection [OR], 23.7 ± 12.0 pg/ml; laparoscopic tumor resection [LR], 30.7 ± 15.5 pg/ml; p = 0.334) nor at the time of tissue harvest (OR, 19.9 ± 19.6 pg/ml; LR, 26.9 ± 34.5 pg/ml; p = 0.549). Conclusions Laparoscopic hepatic resection produces decreased VEGF mRNA expression in residual hepatoma cells compared with open resection. Decreased stimulation of angiogenesis promoters in the tumor microenvironment after minimally invasive liver resection may contribute to a lower residual disease burden and ultimately lead to a lower recurrence rate. Content Type Journal ArticleDOI 10.1007/s00464-009-0742-6Authors Kyle A. Perry, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USAC. Kristian Enestvedt, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USALuke W. Hosack, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USAThai H. Pham, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USABrian S. Diggs, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USASwee Teh, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USASusan Orloff, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USAShelly Winn, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USAJohn G. Hunter, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USABrett C. Sheppard, Oregon Health and Science University Department of Surgery Mail Code L223A, 3181 Sam Jackson Park Road Portland OR 97239 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus

Abstract Background Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett’s neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage. Methods Retrospective series from two tertiary referral centers were studied. Patients with EBN referred for EUS evaluation before treatment were identified, and data were collected from endoscopies, a database, and case notes. All patients had high-resolution endoscopy followed by radial EUS. Results This study included 50 patients (22 men) with a median age of 69 years (interquartile range, 60–79 years). Visible lesions in the Barrett’s segment were described as Paris types 0–1 (n = 9), 0–IIb (n = 12), 0–IIa (n = 12), 0–IIa + IIc (n = 6), and 0–IIc (n = 5). Of the 50 patients, 46 (92%) had either EMR (n = 17), esophagectomy (n = 23), or both (n = 6). All 12 patients (100%) with Paris 0–IIb lesions had T0/T1 m staging on EUS confirmed with resection histology. The sensitivity for EUS T-staging for Paris classification was 71.4% for type 0–I, 100% for type 0–IIb, 83% for type 0–IIa, 66.7% for type 0–IIa + IIc, and 66.7% for type IIc. Overall, 8 (17%) of the 46 patients were understaged and 2 (4%) were overstaged. For detecting submucosal invasion, EUS had a sensitivity of 66%, a specificity of 93%, a negative predictive value of 85%, and a diagnostic accuracy of 84.4%. Conclusion Submucosal invasion is detected by EUS for 26% of patients with EBN. The value of EUS staging before resection for type 0–IIb early Barrett’s cancer (flat lesions) is limited because 100% of these lesions are limited to the mucosa. For the management algorithm in this selected cohort, the use of EUS should be reconsidered. Content Type Journal ArticleDOI 10.1007/s00464-009-0737-3Authors T. Thomas, Nottingham University Hospitals NHS Trust Nottingham Digestive Diseases Centre and Biomedical Research Unit Queens Medical Centre Campus Nottingham NG7 2UH UKD. Gilbert, Western General Hospital Gastrointestinal Unit Edinburgh EH4 2XU UKP. V. Kaye, Nottingham University Hospitals NHS Trust Nottingham Digestive Diseases Centre and Biomedical Research Unit Queens Medical Centre Campus Nottingham NG7 2UH UKI. Penman, Western General Hospital Gastrointestinal Unit Edinburgh EH4 2XU UKG. P. Aithal, Nottingham University Hospitals NHS Trust Nottingham Digestive Diseases Centre and Biomedical Research Unit Queens Medical Centre Campus Nottingham NG7 2UH UKKrish Ragunath, Nottingham University Hospitals NHS Trust Nottingham Digestive Diseases Centre and Biomedical Research Unit Queens Medical Centre Campus Nottingham NG7 2UH UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study

Abstract Background Only a few series have demonstrated the safety of laparoscopic resection for hepatocellular carcinoma (HCC) and the benefits of this approach. Moreover, these studies reported mostly minor and nonanatomic hepatic resections. This report describes the results of a pair-matched comparative study between open and laparoscopic liver resections for HCC in a series of essentially anatomic resections. Methods Patients were retrospectively matched in pairs for the following criteria: sex, age, American Society of Anesthesiology (ASA) score, severity of liver disease, tumor size, and type of resection. A total of 42 patients undergoing laparoscopy were compared with patients undergoing laparotomy during the same period. Surgeons from the authors’ department not trained in laparoscopy performed open resections. Operative, postoperative, and oncologic outcomes were compared. Results The mean duration of surgery was similar in the two groups. Significantly less bleeding was observed in the laparoscopic group (364.3 vs. 723.7 ml; p < 0.0001). Transfusion was required for four patients (9.5%) in the laparoscopic group and seven patients (16.7%) in the open surgery group (p = 0.51). Postoperative ascites was less frequent after laparoscopic resections (7.1 vs. 26.1%; p = 0.03). General morbidity was similar in the two groups (9.5 vs. 11.9%; p = 1.00). The mean hospital stay was significantly shorter for the patients undergoing laparoscopy (6.7 vs. 9.6 days; p < 0.0001). The surgical margin and local recurrence adjacent to the liver stump were not affected by laparoscopy. The overall postoperative survival rates in the laparoscopic group were 93.1% at 1 year, 74.4% at 3 years, and 59.5% at 5 years and, respectively, 81.8, 73, and 47.4% in the open surgery group (p = 0.25). The postoperative disease-free survival rates in the laparoscopic group were at 81.6% at 1 year, 60.9% at 3 years, and 45.6% at 5 years, respectively, 70.2, 54.3, and 37.2% in the open surgery group (p = 0.29). Conclusions Laparoscopic resection of HCC for selected patients gave a better postoperative outcome without oncologic consequences. Prospective trials are required to confirm these results. Content Type Journal ArticleDOI 10.1007/s00464-009-0745-3Authors Hadrien Tranchart, Antoine Béclère Hospital Department of General Surgery 157 rue de la Porte de Trivaux 92141 Clamart Cedex FranceGiuseppe Di Giuro, Antoine Béclère Hospital Department of General Surgery 157 rue de la Porte de Trivaux 92141 Clamart Cedex FrancePanagiotis Lainas, Antoine Béclère Hospital Department of General Surgery 157 rue de la Porte de Trivaux 92141 Clamart Cedex FranceJean Roudie, Chu de Fort-de-France Department of General Surgery 97200 Martinique FranceHelene Agostini, Antoine Béclère Hospital Clinical Research Unit APHP 157 rue de la Porte de Trivaux 92141 Clamart Cedex FranceDominique Franco, Antoine Béclère Hospital Department of General Surgery 157 rue de la Porte de Trivaux 92141 Clamart Cedex FranceIbrahim Dagher, Antoine Béclère Hospital Department of General Surgery 157 rue de la Porte de Trivaux 92141 Clamart Cedex France Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Can endoscopic palliation of large neoplasm increase the risk of pancreatitis after endoscopic retrograde cholangiopancreatography?

Can endoscopic palliation of large neoplasm increase the risk of pancreatitis after endoscopic retrograde cholangiopancreatography? Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0719-5Authors Gianfranco Fanello, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyFausto Fiocca, “Sapienza” University of Rome, Policlinico Umberto I Department of Emergency Surgery, Emergency Endoscopic Unit Viale del Policlinico, 155 00161 Rome ItalyMichele Benedetti, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyGabriele Martino, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyMichele Marengo, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyRoberto Luca Meniconi, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyFederica Papini, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome ItalyPiero Chirletti, “Sapienza” University of Rome, Policlinico Umberto I Department of Surgery, “F. Durante”–General Surgery Unit Viale del Policlinico, 155 00161 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Erratum to: Surgical Endoscopy volume 21(12); volume 22(2)

Erratum to: Surgical Endoscopy volume 21(12); volume 22(2) Content Type Journal ArticleCategory ErratumDOI 10.1007/s00464-009-0717-7Authors B. B. Agarwal, Sir Ganga Ram Hospital Department of General Surgery New Delhi 110060 India Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures

Abstract Background Natural orifice transluminal endoscopic surgery (NOTES) and transumbilical endoscopic surgery (TUES) are being developed to improve minimally invasive surgery further. In 2006, the authors developed TUES using a single triple-channel trocar or single-trocar (ST) technique. To minimize the risk and improve the surgical efficiency further, the procedure was optimized using a two-trocar (TT) technique, with both trocars in the umbilicus. This study compared the clinical results for the TT and ST techniques. Methods For this study, 32 patients with chronic gallbladder disease and indications for cholecystectomy were randomly assigned to undergo surgery with either the TT technique (17 patients) or the ST technique (15 patients). With the TT procedure, two modified 5-mm trocars with small handles were inserted through the navel, one above and one below the umbilicus. Another 2-mm trocar was inserted for a grasper in the right upper abdomen. With the ST procedure, one 15-mm umbilical incision was made for insertion of a previously developed triple-channel trocar to apply the laparoscope, grasper, and dissector individually. Operation time, postoperative hospital stay, and postoperative pain were compared between the two procedures. Results The mean operative time was significantly shorter with the TT technique (35.71 ± 9.74 min) than with the ST technique (125.25 ± 18.9 min (p < 0.001). Use of analgesics after surgery also was less in the TT group than in the ST group (0 vs. 7, respectively; p < 0.05). The postoperative hospital stay did not differ significantly between the two groups (p > 0.05). Conclusions Although both procedures were based on the transumbilical approach, the TT approach was found to be faster and less painful than the ST approach. The difference in the cosmetic result was minimal. Content Type Journal ArticleDOI 10.1007/s00464-009-0730-xAuthors Hai Hu, Tongji University Affiliated Shanghai East Hospital Department of Minimally Invasive Surgery 150 Jimo Road, Pudong New District Shanghai 200120 People’s Republic of ChinaJiangfan Zhu, Tongji University Affiliated Shanghai East Hospital Department of Minimally Invasive Surgery 150 Jimo Road, Pudong New District Shanghai 200120 People’s Republic of ChinaWeidong Wang, Tongji University Affiliated Shanghai East Hospital Department of Minimally Invasive Surgery 150 Jimo Road, Pudong New District Shanghai 200120 People’s Republic of ChinaAnhua Huang, Tongji University Affiliated Shanghai East Hospital Department of Minimally Invasive Surgery 150 Jimo Road, Pudong New District Shanghai 200120 People’s Republic of China Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

The first endoscopic retrograde pancreatogram

The first endoscopic retrograde pancreatogram Content Type Journal ArticleDOI 10.1007/s00464-009-0725-7Authors Fred Brody, The George Washington University Medical Center Department of Surgery 2150 Pennsylvania Avenue NW Suite 6B Washington DC 20037 USAKhashayar Vaziri, The George Washington University Medical Center Department of Surgery 2150 Pennsylvania Avenue NW Suite 6B Washington DC 20037 USATodd A. Ponsky, Case Western Reserve University Department of Surgery Cleveland OH USABrian J. Dunkin, The Methodist Hospital Department of Surgery Houston TX USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera

Abstract Background This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. Methods In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. Results The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. Conclusion The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery. Content Type Journal ArticleDOI 10.1007/s00464-009-0740-8Authors Seong-Ho Kong, Seoul National University College of Medicine Department of Surgery 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaByung-Mo Oh, Seoul National University College of Medicine Department of Rehabilitation Medicine 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaHongman Yoon, Seoul National University College of Medicine Department of Surgery 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaHye Seong Ahn, Seoul National University College of Medicine Department of Surgery 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaHyuk-Joon Lee, Seoul National University College of Medicine Department of Surgery 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaSun Geun Chung, Seoul National University College of Medicine Department of Rehabilitation Medicine 28 Yongon-dong, Chongno-gu Seoul 110-744 KoreaNorio Shiraishi, Oita University Department of Surgery I, Faculty of Medicine Oita JapanSeigo Kitano, Oita University Department of Surgery I, Faculty of Medicine Oita JapanHan-Kwang Yang, Seoul National University College of Medicine Department of Surgery 28 Yongon-dong, Chongno-gu Seoul 110-744 Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Natural orifice transluminal endoscopic surgery (NOTES): when a step forward may be a step too soon or too far

Natural orifice transluminal endoscopic surgery (NOTES): when a step forward may be a step too soon or too far Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0722-xAuthors Olivier Detry, University of Liège Department of Abdominal Surgery and Transplantation Sart Tilman B35 4000 Liege BelgiumBerthier Nsadi, University of Liège Department of Abdominal Surgery and Transplantation Sart Tilman B35 4000 Liege BelgiumLaurent Kohnen, University of Liège Department of Abdominal Surgery and Transplantation Sart Tilman B35 4000 Liege Belgium Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring

Abstract Background Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication. Methods In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication. Results The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008). Conclusion Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered. Content Type Journal ArticleDOI 10.1007/s00464-009-0723-9Authors Daniel von Renteln, Klinikum Ludwigsburg Department of Gastroenterology, Hepatology, and Oncology Posilipostrasse 4 71640 Ludwigsburg GermanyArthur Schmidt, Klinikum Ludwigsburg Department of Gastroenterology, Hepatology, and Oncology Posilipostrasse 4 71640 Ludwigsburg GermanyBettina Riecken, Klinikum Ludwigsburg Department of Gastroenterology, Hepatology, and Oncology Posilipostrasse 4 71640 Ludwigsburg GermanyKarel Caca, Klinikum Ludwigsburg Department of Gastroenterology, Hepatology, and Oncology Posilipostrasse 4 71640 Ludwigsburg Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Efficacy and safety of azelastine 0.15% nasal spray and azelastine .010% nasal spray in patients with seasonal allergic rhinitis.

Efficacy and safety of azelastine 0.15% nasal spray and azelastine .010% nasal spray in patients with seasonal allergic rhinitis. Allergy Asthma Proc. 2009 Nov 19; Authors: Shah S, Berger W, Lumry W, Laforce C, Wheeler W, Sacks H Azelastine is a second-generation antihistamine approved for treatment of allergic rhinitis. This randomized, double-blind, placebo- and active-controlled, parallel-group clinical trial evaluated the efficacy and safety of azelastine 0.15% and azelastine0.10% nasal spray at a dosage of 2 sprays/nostril twice daily in patients with moderate-to-severe seasonal allergic rhinitis (SAR). In total, 526 patients were randomized 1:1:1 to treatment with 2 sprays/nostril twice daily of azelastine 0.15%,azelastine 0.10%, or placebo. The primary efficacy variable was change from baseline in 12-hour reflective Total Nasal Symptom Score (TNSS; A.M. and P.M. combined), consisting of nasal congestion, rhinorrhea, itchy nose, and sneezing. After 2 weeks, the mean improvement and percentage improvement in the 12-hour reflective TNSS were significant (p < 0.001) withazelastine 0.15% and azelastine 0.10% compared with placebo. In a retrospective analysis, there was a statistical difference (p = 0.047) in the mean improvement versus placebo in the 12-hour reflective TNSS with azelastine 0.15% compared with azelastine 0.10%. Onset of action with azelastine 0.15% was within 30 minutes. Bitter taste was the most common adverse event with both azelastine 0.15% and azelastine 0.10% (8.4% and 9.4% of patients, respectively). Somnolence was reported by 1.7% ofpatients treated with azelastine 0.15%, 0.6% of patients treated with azelastine 0.10%, and 0.6% of patients treated with placebo. Azelastine 0.15% nasal spray at 2 sprays/nostril twice daily significantly improved the nasal symptoms associated with SAR with an onset of action within 30 minutes and was well tolerated. PMID: 19930788 [PubMed - as supplied by publisher]