Conscious sedation : clues for diagnosing obstructive sleep apnea syndrome.

BACKGROUND: The use of anesthetic agents for endoscopic sedation has recently increased. However, sedation introduces additional risks in patients with obstructive sleep apnea syndrome (OSAS). The presence of sleep apnea is not often enough questioned in clinical practice. The purpose of this study was to determine whether patients with sedation-induced snoring and decreased arterial oxygen saturation during gastroscopy are more likely to have OSAS. METHOD: This study considered 600 consecutive patients undergoing elective outpatient upper gastrointestinal endoscopy under conscious sedation for evaluation of dyspepsia. Ten patients with observed snoring and decreased arterial saturation during the gastroscopy procedure were enrolled in the study. The control group was comprised of 13 patients matched by sex, age, and body mass index (BMI) who did not snore and had a more stable oxygen saturation under conscious sedation during an elective outpatient gastroscopy for the evaluation of dyspepsia and were selected using a computer-generated randomized sequence. Patients were monitored and an overnight polysomnography was performed in the study group. Statistically significant differences between groups were assessed using the nonparametric Wilcoxon and independent-samples t-tests. RESULTS: here was no significant difference in age or BMI between the two groups (p>0,05) Mean minimum oxygen saturation was significantly different between the two groups (p=0.011). In the study group, 7 patients were found to have moderate OSAS necessitating a continuous positive airway pressure device. CONCLUSIONS: Patients with hypoxia and snoring, under conscious sedation are more likely to have OSAS. "Out-of-operating-room" sedoanalgesia is therefore critical. (Acta gastro-enterol. belg., 2016, 79, 289-293).

Does the urea breath test predict eradication of Helicobacter pylori infection?

BACKGROUND AND AIM: Helicobacter pylori infection is common world-wide and has been linked to development of gastric and duodenal ulcers, gastric adenocarcinoma, and gastric lymphoma. However, antimicrobial resistance has decreased H. pylori eradication rates worldwide. This study aimed to evaluate the effect of -bacterial load on eradication rate. METHOD: This prospective study included 237 consecutive patients who presented to our institution with dyspeptic symptoms and underwent both upper endoscopy and urea breath tests (UBT). The patients were divided into three equal sized groups according to their UBT values. All subjects received a standard triple eradication regimen, followed by a bismuth- based quadruple eradication regimen if triple eradication was not successful. The three groups were compared with respect to age, endoscopic findings, sex, and eradication rates. RESULTS: Our results were consistent with those of previous studies : higher UBT values were associated with failure of standard 14-day triple treatment (p < 0.05). However, in patients who received a quadruple eradication regimen, differences between groups were not significant (p = 0.434). There was no relationship between UBT values and gastric pathologies (p = 0.751). Age and sex also did not differ significantly between groups (p = 0.061). CONCLUSIONS: Our study and others have found that high bacterial loads are negatively associated with achievement of eradication with triple treatment. However, differences between groups were not significant in patients who received a quadruple eradication regimen. Comparisons of treatment results according to bacterial density may be informative. The importance of H. pylori density should be further evaluated with new treatment protocols.

Reactivation of Resolved Hepatitis B virus Infection before the Relapse of Lymphoma : Immunosuppressive effect of the Lymphoproliferative disorders?

Hepatitis B virus (HBV) infection is a heterogeneous disease with distinct phases determined mainly by the interaction between virus replication and host immune response. HBV reactivation can occur spontaneously, developing resistance to antiviral treatment while the patient is undergoing treatment, after cessation of antiviral drugs, or be triggered by immunosuppressive drugs and chemotherapy. HBV reactivation can be severe and sometimes fatal because of liver failure. Here we report a patient with resolved HBV infection who presented with reactivation before being diagnosed with a relapse of non-Hodgkin lymphoma.

A rare case of heterotopic pancreas in the stomach which caused closed perforation.

Heterotopic pancreas is the presence of an abnormally located focus of normally developed pancreatic tissue outside the boundaries of the orthotopic pancreas, without anatomical or vascular connections. Heterotopic pancreas is usually found incidentally and is generally asymptomatic. However, the lesion can become symptomatic depending on the size, location and the pathological changes. We present the case of a 19-year-old female patient with a perforated heterotopic pancreas of the gastric antrum. There have been no reports describing perforated gastric heterotopic pancreas and it should always be considered in the differential diagnosis of gastric masses and acute abdomen.

Effect of neocuproine, a selective Cu(I) chelator, on nitrergic relaxations in the mouse corpus cavernosum.

The effects of neocuproine and bathocuproine, Cu(I) and Cu(II) chelators, respectively, were studied on relaxations in response to electrical field stimulation, acetylcholine, S-nitrosoglutathione, acidified sodium nitrite and sodium nitroprusside in the mouse corpus cavernosum precontracted with phenylephrine. Neocuproine significantly inhibited relaxations induced by electrical field stimulation, acetylcholine and S-nitrosoglutathione, but not by acidified sodium nitrite and sodium nitroprusside. The pre-prepared neocuproine-Cu(I) complex was ineffective on the responses. The discrepancy between the shape of relaxations in response to electrical field stimulation or to acetylcholine and S-nitrosoglutathione was abolished by adding CuCl(2) into the bathing medium. The copper action was blocked by neocuproine but not by bathocuproine. However, the pre-prepared bathocuproine-Cu(II) complex did not accelerate the relaxations affected by CuCl(2). These findings suggest that a Cu(I)-dependent mechanism may play a role in the relaxation induced by the endogenous relaxant factor as well as by S-nitrosoglutathione in mouse cavernosal tissue.