May chronic cough in chronic obstructive pulmonary disease be a contraindication of Percutaneous Endoscopic Gastrostomy placement: a case report.

BACKGROUND: Percutaneous Endoscopic Gastrostomy (PEG) can involve some complications, despite the good safety of its track record. The Buried Bumper Syndrome (BBS) is a rare, late and dangerous complication that consists in the erosion of the internal bumper through the gastric wall. Case presentation We report the development of BBS in a man with chronic obstructive pulmonary disease (COPD) who had a persistent chronic cough which was prevalently but not solely in the morning and required placement of a PEG tube for continuous infusion of Levodopa/carbidopa intestinal gel for advanced Parkinson's disease. CONCLUSION: We believe that COPD with chronic cough while not representing an absolute contraindication to PEG placement, may potentially cause BBS and therefore an appropriate regimen of tube care by expert personnel is mandatory in this setting.

Evaluation of the intraepithelial papillary capillary loops in benign and malignant oral lesions by in vivo Virtual Chromoendoscopic Magnification: a preliminary study.

This preliminary study aims to establish the Virtual Chromoendoscopic Magnification (VCM) feasibility to visualize and distinguish the Intraepithelial Papillary Capillary Loops (IPCL) patterns of benign oral pathologies from malignant ones. Thirty-one consecutive subjects affected by oral lesions/pathologies underwent white light examination and VCM imaging by the Narrow Band Imaging System (Olympus Medical Systems Corp., Tokyo, Japan). A class system of four IPCL types corresponding to progressive vessel disarray was adopted. IPCL type IV were considered criterion of “malignancy”. A histopathological exam completed the diagnosis: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. IPCL patterns of benign oral entities ranged from types I to III. IPCL type IV was associated with malignancy in 4 out of 6 cases. Sensitivity, specificity, PPV, and NPV were 100%, 93%, 67% and 100%, respectively. This study preliminarily describes IPCL patterns of different oral mucosal diseases and confirms the association between IPCL IV and oral cancer.

Continuous intra jejunal infusion of levodopa-carbidopa intestinal gel by jejunal extension tube placement through percutaneous endoscopic gastrostomy for patients with advanced Parkinson's disease: a preliminary study.

OBJECTIVE: Levodopa is the gold standard in the pharmacological treatment of Parkinson's disease (PD) and its oral administration is associated with the development of disabling motor and non-motor complications in advanced disease. Levodopa is rapidly metabolized and has a short plasma half-life thus requiring frequent, repeated dosing. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa. A new therapeutic protocol for patients with advanced PD include a carbidopa/levodopa combination using continuous, modulated enteral administration achieved inserting a Jejunal Extension Tube Placement through Percutaneous Endoscopic Gastrostomy (PEG-J). The aim of this work is to assess efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) delivered continuously through an intrajejunal percutaneous tube (PEG-J). PATIENTS AND METHODS: We enrolled 11 adults with advanced PD and preserved sensitivity to L-dopa. For pre-procedural endoscopic evaluation each patient underwent a diagnostic esophagogastroduodenoscopy (EGD) 7 days before PEG-J placement to evaluate the presence of gastric anatomical or wall anomalies and the presence of oesophageal or gastric varices. Treatment with LCIG, consisting of a water-based suspension containing micronized levodopa (20 mg/mL) and carbidopa (5 mg/mL) in methylcellulose (Duodopa®), was administered by continuous jejunal infusion for 12h/day using a portable pump (CADD-Legacy) by PEG-J. Clinical evaluations were performed at baseline (T0) before LCIG initiation, and after 3 (T3) and 6 (T6) months of therapy. The efficacy and safety outcomes were assessed by using the Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III and IV. RESULTS: Mean age of patients was 71.18 ± 5.4 SD at LCIG initiation. Out of the 11 patients, 2 (18%) dropped-out LCIG at T3. Patients showed statistically significant (p < 0.05) higher performances in activities of daily living and a statistically significant (p < 0.001) lower incidence and severity of motor fluctuations, as rating by UPDRS part IV, compared to their best oral therapy. During observational period, 5 patients experienced adverse events. Success rate for PEG-J placement was 100%. CONCLUSIONS: Our work shows that continuous intrajejunal infusion of LCIG ensures a reduction in motor Fluctuations compared to oral administration of levodopa-carbidopa in advanced PD. Based on our results and on the evidence emerging in the literature, this therapeutic approach should be the gold standard for therapy in these patients.

Refractory gastric antral vascular ectasia: a new endoscopic approach.

Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.

[Non-alcoholic hepatic steatosis: the role of policosanols in associated hyperlipidemia]. / La steatosi epatica non alcolica: il ruolo dei policosanoli nelle iperlipemie associate.

AIM: The purpose of this study was to evaluate the efficacy of policosanols in the treatment of associated hyperlipidemia in patients with non-alcoholic fatty liver disease (NAFLD). METHODS: We conducted a retrospective study on 52 patients with NAFLD. Pretreatment patients' data (total cholesterol, LDL cholesterol, triglycerides, ALT, and AST) were collected and analyzed. Furthermore, based on weight and height, we calculated the Body Mass Index (BMI) and, based on blood glucose and insulin levels, we estimated the Human Omeostatic Assesment Index (HOMA). After that, all patients were treated with a policosanols' supplement (Frilipid®) and a hypocaloric balanced diet, and then followed over time with quarterly inspections. We collected and analyzed data on three subsequent quarterly monitoring during treatment. RESULTS: The collected and analyzed data showed a significant reduction in total cholesterol, LDL cholesterol and HOMA index (P<0.002). It was also found a trend not statistically significant for a marked reduction in ALT, AST, triglycerides, and BMI. CONCLUSION: The use of policosanols is shown effective in the treatment of associated hyperlipidemia and insulin resistance in patients with fatty liver disease.

Auditory association cortex lesions impair auditory short-term memory in monkeys.

Monkeys that were trained to perform auditory and visual short-term memory tasks (delayed matching-to-sample) received lesions of the auditory association cortex in the superior temporal gyrus. Although visual memory was completely unaffected by the lesions, auditory memory was severely impaired. Despite this impairment, all monkeys could discriminate sounds closer in frequency than those used in the auditory memory task. This result suggests that the superior temporal cortex plays a role in auditory processing and retention similar to the role the inferior temporal cortex plays in visual processing and retention.

On the limits of the matching concept in monkeys (Cebus apella).

Two cebus monkeys, with many years of experience matching a variety of static visual stimuli (forms and colors) within a standard matching-to-sample paradigm, were trained to press a left lever when a pair of displayed static stimuli were the same and to press a right lever when they were different. After learning the same/different task, the monkeys were tested for transfer to dynamic visual stimuli (flashing versus steady green disks), with which they had no previous experience. Both failed to transfer to the dynamic stimuli. A third monkey, also with massive past experience matching static visual stimuli, was tested for transfer to the dynamic stimuli within our standard matching paradigm, and it, too, failed. All 3 subjects were unable to reach a moderate acquisition criterion despite as many as 52 sessions of training with the dynamic stimuli. These results provide further evidence that, in monkeys, the matching (or identity) concept has a very limited reach; they consequently do not support the view held by some theorists that an abstract matching concept based on physical similarity is a general endowment of animals.

Serial learning with wild card items by monkeys (Cebus apella): implications for knowledge of ordinal position.

We investigated monkeys' knowledge of the ordinal positions of stimuli that formed a 5-item serial list, ABCDE, by means of wild card items (W) that could substitute for items in the original series. In Experiment 1, training with wild cards was given on 3-, 4-, and 5-item series. In the last of these series, the wild card substitutions created five wild card sequences, WBCDE through ABCDW. During the final 10 sessions of training with each of two different wild cards (Items x and Y), the 3 subjects were able to successfully complete almost 60% of the wild card sequences. In Experiment 2, the two wild cards were presented on the same trial in 10 different double wild card sequences (e.g., AXCDY). The 2 monkey subjects correctly completed about 59% of the double wild card sequences during the final two training sessions. The performance levels achieved on single and on double wild card sequences, although well below that observed on the baseline sequence ABCDE (90% or better), support the view that the monkeys possessed some knowledge regarding the ordinal position of each baseline item. Consequently, an associative chain interpretation, which does not provide for knowledge of ordinal position, falls short as a complete account of the monkey's capacity for serial learning.

Representation of serial order in monkeys (Cebus apella).

Cebus monkeys were trained on a five-item serial learning task, symbolized as ABCDE; the initial stages of training were on the shorter subseries AB, ABC, and ABCD. To assess the monkeys' knowledge of the sequential position of each item, pair-wise tests were given to 2 subjects after acquisition of the ABCD series and to 4 subjects after reaching criterion on the ABCDE series. In both tests, the monkeys performed at high levels on the interior pairs, which were BC for the ABCD series, and BC, BD, and CD for the ABCDE series. These results, as well as the orderly relations observed in the pair-wise tests between first-item response latency and first-item position and between second-item response latency and number of missing items, indicated that the monkeys had developed a well-organized internal representation of the four- and five-item series. Although pigeons are also capable of learning four-item and five-item series, they apparently do not develop a comparable representational structure. The disparity between the monkeys' and pigeons' representational competence for serial order is predictable from the difference in their capacities for associative transitivity.

Symmetry and transitivity of conditional relations in monkeys (Cebus apella) and pigeons (Columba livia).

In Experiment 1 six monkeys were tested with discriminative relations that were backward relative to their training in a 0-second conditional ("symbolic") matching procedure. Although there was some indication of backward associations, the evidence was generally weak, and statistical evaluations did not reach conventional significance levels. Unlike children, who show backward associations to the point of symmetry, monkeys and pigeons display at best only weak and transient backward associations. In Experiment 2 associative transitivity was assessed across two sets of conditional matching tasks. All four monkeys tested demonstrated strong transitivity. In contrast, in Experiment 3 there was no evidence of transitivity in three pigeons tested under conditions closely comparable to those of Experiment 2. These results may identify some key features of interspecies differences and contribute to analyses of serial learning in animals.

Extent and limits of the matching concept in monkeys (Cebus apella).

In Experiment 1, 8 monkeys, experimentally naive with regard to visual stimuli, were trained on identity matching with a two-sample set based on two-dimensional stimuli. On a subsequent test employing two new samples, 4 of the 8 applied the matching rule to the new sample stimuli (as defined by our transfer criterion), and 3 showed substantial savings in learning to match the new samples. Two of these 3 transferred the matching rule when given a second test with two new samples, and the third showed immediate and complete transfer when tested with a third pair of new stimuli. These results indicate a much stronger representation of the matching concept in monkeys than in pigeons, even when the conditions of assessment are reasonably comparable. In Experiment 2, however, 4 monkeys from Experiment 1 failed to transfer the matching rule to steady versus flashing green samples, indicating that the matching concept did not immediately extend beyond the general class of visual stimuli with which it was developed. These and related results in the literature suggest that representation of the matching concept in animals varies along a specificity-abstractness dimension, reflecting the degree to which the concept is tied to the conditions and context of its development.

Note on delay-interval illumination effects on retention in monkeys (Cebus apella).

Two monkeys experienced with delayed matching to sample were given a 30-day baseline training period during which the delay interval was illuminated. Both subjects showed an increase in matching accuracy when shifted to dark delay intervals, and accuracy declined when the illuminated delay interval was reinstituted. These results, as well as earlier reports of facilitation of delayed matching behavior by dark delay intervals, support the view that the absolute level of delay-interval illumination can importantly affect visual retention in monkeys and may be indicative of significant differences in the retention mechanisms employed by monkeys and birds.

Incentive contrast undiminished by extended testing, imipramine, or chlordiazepoxide.

In three experiments rats were given alternating 1-minute access periods to two tubes containing sucrose solutions. When the tubes contained disparate concentrations (32% versus 4%), lick-rate was higher for the 32% solution than it was when both tubes contained 32% (a positive contrast effect) and less for 4% than when both tubes contained 4% (a negative contrast effect). Similar, but generally less pronounced, contrast effects were obtained in latency to initiate drinking. These contrast effects showed no sign of diminution with repeated exposure (32 days of repeated shifts in Experiments 1 and 3); they were not greatly influenced by injections of imipramine (Experiment 2) or chlordiazepoxide (Experiment 3), nor by deprivation conditions (Experiment 3), nor by deprivation conditions (Experiment 3). The results supported an explanation of simultaneous contrast in terms of sensory-perceptual processes rather than in terms of generalization decrement or emotional responses.

Effect of delay-interval illumination on matching behavior in the capuchin monkey.

Experiment 1 demonstrated that delayed matching-to-sample in the capuchin monkey was superior when the delay interval was spent in darkness rather than in moderate illumination. In contrast with previous studies in which the delayed-matching ability of primates appeared limited to 60 sec or less, in the dark condition all subjects showed above-chance matching at a 120-sec delay interval. Experiment 2 verified that darkness during the delay interval can facilitate delayed matching and provided evidence that the effective variable was the illumination level of the delay interval rather than change in illumination, which in Exp. 1 was confounded with illumination level.