The efficiency of quartz addition on electric arc furnace (EAF) carbon steel slag stability.

Electric arc furnace slag (EAF) has the potential to be re-utilized as an alternative to stone material, however, only if it remains chemically stable on contact with water. The presence of hydraulic phases such as larnite (2CaO SiO2) could cause dangerous elements to be released into the environment, i.e. Ba, V, Cr. Chemical treatment appears to be the only way to guarantee a completely stable structure, especially for long-term applications. This study presents the efficiency of silica addition during the deslagging period. Microstructural characterization of modified slag was performed by SEM and XRD analysis. Elution tests were performed according to the EN 12457-2 standard, with the addition of silica and without, and the obtained results were compared. These results demonstrate the efficiency of the inertization process: the added silica induces the formation of gehlenite, which, even in caustic environments, does not exhibit hydraulic behaviour.

[Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients]. / Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico.

INTRODUCTION: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). OBJECTIVES: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. METHODS: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. RESULTS: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. CONCLUSIONS: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BED.

Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico / Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients

Introducción: La presencia de trastorno por atracón (TA) podría influir en los resultados del bypass gástrico laparoscópico (BPGL) en el tratamiento de la obesidad mórbida. En población anglosajona, el TA suele valorarse mediante los cuestionarios Eating Disorder Examination-Questionnaire (EDE-Q) y Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objetivos: Estudiar la validez y concordancia del EDEQ y QEWP-R para el diagnóstico y valoración psicopatológica del TA en población española con obesidad mórbida intervenida mediante BPGL. Métodos: En un estudio transversal se le ha solicitado a 27 obesos mórbidos recién intervenidos mediante BPGL que cumplimentaran el EDE-Q y QEWP-R traducidos al español. Según las respuestas se han identificado los pacientes con y sin TA, evaluando posibles diferencias entre estos grupos en los ítems con interés psicométrico y midiendo la concordancia entre ambos cuestionarios. Resultados: El QEWP-R permitió diagnosticar un 25,9% de TA y el EDE-Q un 18,5%. Los pacientes con TA tuvieron mayores puntuaciones en los ítems sobre la importancia del peso o figura en la autovaloración, la interferencia en la capacidad de concentración por pensar en la comida, silueta o peso y la frecuencia del sentimiento de culpa después de comer. Entre ambos cuestionarios la concordancia diagnóstica fue escasa, pero se encontró una asociación fuerte entre los ítems con interés psicométrico. Conclusiones: El TA es frecuente en obesos mórbidos intervenidos mediante BPGL y forma un subgrupo de pacientes con más alteraciones psicopatológicas. El QEWP-R y el EDE-Q en español son cuestionarios adecuados para su valoración (AU)

Introduction: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objectives: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. Methods: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. Results: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. Conclusions: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BE (AU)

Mesquite pod extract modifies the reproductive physiology and behavior of the female rat.

Phytoestrogens are non steroidal compounds that can bind to estrogen receptors, mimicking some effects of estradiol (E(2)). These compounds are widespread among legumes, which are used as pasture, and their importance in animal agriculture has increased. Mesquite (Prosopis sp) is a widespread legume, widely used to feed several livestock species in Mexico. The main product of mesquite is the pod, which is considered high quality food. As a legume, it could be assumed that mesquite contains some amounts of phytoestrogens which might induce potential estrogenic effects. However, to our knowledge, there are no reports regarding the possible estrogenic activity of this legume either in livestock or in animal models such as the rat. Therefore, in this study, we evaluated the potential estrogenic effects of mesquite pod extract on several aspects of behavior and reproductive physiology of the female rat. The effects of the extract were compared with those of E(2) and two isoflavones: daidzein (DAI) and genistein (GEN). The following treatments were given to groups of intact and ovariectomized (OVX) female rats: vehicle; mesquite pod extract; E(2); GEN; DAI. Compared to vehicle groups, mesquite pod extract, DAI, GEN, and E(2) increased uterine weight and induced growth in vaginal and uterine epithelia. In intact rats, mesquite pod extract, GEN and DAI altered estrous cyclicity, decreased lordotic quotient and intensity of lordosis. In OVX rats, mesquite pod extract, DAI and GEN induced vaginal estrus, increased vaginal epithelium height, and induced lordosis, although its intensity was reduced, compared with intact rats in estrus and E2-treated rats. These results suggest that mesquite pod extract could have estrogenic activity. However, the presence of phytoestrogens in this legume remains to be confirmed.

Systematic review of the clinical efficacy of sibutramine and orlistat in weigth loss, quality of life and its adverse effects in obese adolescents.

INTRODUCTION: The prevalence of obesity, a serious public health problem, is increasing among teenagers and thus also increases cardiovascular morbidity and mortality in adulthood. OBJECTIVE: To provide a systematic review of the best evidence about the effect of sibutramine and orlistat in weight loss, quality of life and its adverse effects in adolescents diagnosed with obesity. METHODS: We searched electronic databases and bibliographies of selected articles were inspected for any further reference. We included only randomized controlled trials that met a set of predefined criteria. The studies were reviewed by a narrative synthesis. RESULTS: We included 6 randomized controlled trials of sibutramine and 3 of orlistat. The majority reached a moderate to high methodological quality. Sibutramine and orlistat showed a reduction in body mass index (BMI) that was significantly higher compared with the placebo group. We also found a variation of weight with these drugs significantly better than placebo. Only one trial evaluated the quality of life. The incidence of adverse effects was similar for sibutramine and placebo, except for tachycardia. The most common adverse reactions associated with orlistat were gastrointestinal, mild to moderate. CONCLUSIONS: Sibutramine and orlistat in combination with a hypocaloric diet and changes in lifestyle in obese adolescents achieve a short-term loss of weight greater than that achieved through the dietary-behavioral therapy alone.

Preoperative determinants of outcomes of laparoscopic gastric bypass in the treatment of morbid obesity / Determinantes preoperatorios de resultados del bypass gástrico laparoscópico en el tratamiento de la obesidad mórbida

Introduction: Laparoscopic gastric bypass (LGBP) is the predominant technique in surgical treatment of morbidobesity. Objectives: To evaluate the results of LGBP and measure the validity of some hypothetical variables as predictors of these outcomes. Methods: We carried out a historical cohort study which included 50 morbidly obese patients operated with L GBP. The results were assessed by the Bariatric Analysis and Reporting Outcome System (BAROS), which measures the following parameters: the percentage of excess weight loss (EWL), changes in co-morbidities, quality of life and complications. The independent variables were age, body mass index (BMI), sex, history of depression and presence of more than one cardiovascular risk factor (CVRF).Results: Following LGBP, 11% of the results was classified as excellent, 54% as very good, 25% as good and9% as fair (median follow-up period: 17 months, 7-37).The best scores were found among younger patients. The EWL (mean: 55.4 ± 16.6%) was higher in patients with lower BMI and with no more than one cardiovascular risk factor. We obtained rates of resolution of CVRF of43.7 to 68.7%, complication rates < 10% and improvement of quality of life. Conclusions: We believe that, following LGBP in morbidly obese patients, when EWL, improvement in comorbidities and quality of life as well as complications are jointly assessed, the best results are obtained in younger patients (AU)

Introducción: El bypass gástrico la paroscópico (BPGL)es la técnica predominante en el tratamiento quirúrgico de la obesidad mórbida. Objetivos: Evaluar los resultados del BPGL y medir la capacidad de algunas variables como hipotéticas predictoras de estos resultados. Métodos: En un estudio de cohorte histórico se han incluido 50 obesos mórbidos intervenidos mediante BPGL, valorando los resultados según el sistema BAROS; este considera el porcentaje de sobrepeso perdido (PSP), evolución de comorbilidades, calidad de vida y complicaciones. Las variables independientes han sido la edad, índice de masa corporal (IMC), sexo, presencia o no de historia depresiva y de más de un factor de riesgo cardiovascular (FRCV).Resultados: La clasificación de los resultados del BPGL fue: 11% resultado excelente, 54% resultado muy bueno,25% resultado bueno y 9% resultado regular (mediana de seguimiento postoperatorio: 17 meses, 7-37); las mejores puntuaciones correspondieron a enfermos con menor edad. El PSP (media: 55,4 ± 16,6%) fue mayor en pacientes con menor IMC y con no más de un FRCV. Se obtuvieron unas tasas de resolución de los FRCV del 43,7-68,7%,unos índices de complicaciones < 10% y mejoró la calidad de vida. Conclusiones: Cuando se valora de forma conjunta PSP, evolución de comorbilidades, calidad de vida y complicaciones de los obesos mórbidos intervenidos mediante BPGL, los mejores resultados se obtienen en los pacientes más jóvenes (AU)

Systematic review of the clinical efficacy of sibutramine and orlistatin weigth loss, quality of life and its adverse effects in obese adolescents / Revisión sistemática sobre la eficacia clínica de la sibutramina y el orlistat en la pérdida de peso, calidad de vida y sus efectos adversos en obesos adolescentes

Introduction: The prevalence of obesity, a serious public health problem, is increasing among teenagers and thus also increases cardiovascular morbidity and mortality in adult hood. Objective: To provide a systematic review of the best evidence about the effect of sibutramine and orlist at in weight loss, quality of life and its adverse effects in adolescents diagnosed with obesity. Methods: We searched electronic data bases and bibliographies of selected articles were inspected for any further reference. We included only randomized controlled trials that met a set of predefined criteria. The studies were reviewed by a narrative synthesis. Results: We included 6 randomized controlled trials of sibutramine and 3 of orlistat. The majority reached a moderate to high methodological quality. Sibutramine and or listat showed a reduction in body mass index (BMI) that was significantly higher compared with the placebo group. We also found a variation of weight with these drugs significantly better than placebo. Only one trial evaluated the quality of life. The incidence of adverse effects was similar for sibutramine and placebo, except for tachycardia. The most common adverse reactions associated with orlistat were gastrointestinal, mild tomoderate. Conclusions: Sibutramine and orlistat in combination with a hypocaloric diet and changes in lifestyle in obese adolescents achieve a short-term loss of weight greater than that achieved through the dietary-behavioral therapy alone (AU)

Introducción: La prevalencia de la obesidad, un grave problema de salud pública, está aumentando entre los adolescentes y con ello también se incrementa la morbimortalidad cardiovascular en la edad adulta. Objetivo: Proporcionar una revisión sistemática de la mejor evidencia posible sobre el efecto de sibutramina y orlistat en la pérdida de peso, calidad de vida y sus efectos adversos en adolescentes diagnosticados de obesidad. Método: Se ha buscado en bases de datos electrónicas, las bibliografías de los artículos seleccionados se han inspeccionado en busca de alguna referencia adicional. Sólo se incluyeron ensayos clínicos aleatorizados y controlados que cumplieran una serie de criterios predefinidos. Los estudios se han revisado mediante una síntesis narrativa. Resultados: Se incluyeron 6 ensayos clínicos aleatorizados y controlados sobre la sibutramina y 3 sobre el orlistat. En su mayoría alcanzaron una calidad metodológica moderada-alta. Sibutramina y orlistat demostraron una reducción en el índice de masa corporal (IMC) significativamente mayor en comparación con el grupo placebo. También se encontró una variación del peso significativamente mejor con estos fármacos que con placebo. Únicamente un ensayo evaluó la calidad de vida. La incidencia de efectos adversos resultó similar para sibutramina y placebo, salvo la taquicardia. Las reacciones adversas más comunes asociadas con el orlistat fueron las gastrointestinales, de intensidad leve a moderada. Conclusiones: La sibutramina o el orlistat en combinación con una dieta hipocalórica y modificaciones en el estilo de vida propician en adolescentes obesos una pérdida de peso a corto plazo mayor que la que se conseguiría con el tratamiento dietético-conductual solo (AU)

Preoperative determinants of outcomes of laparoscopic gastric bypass in the treatment of morbid obesity.

INTRODUCTION: Laparoscopic gastric bypass (LGBP) is the predominant technique in surgical treatment of morbid obesity. OBJECTIVES: To evaluate the results of LGBP and measure the validity of some hypothetical variables as predictors of these outcomes. METHODS: We carried out a historical cohort study which included 50 morbidly obese patients operated with LGBP. The results were assessed by the Bariatric Analysis and Reporting Outcome System (BAROS), which measures the following parameters: the percentage of excess weight loss (EWL), changes in co-morbidities, quality of life and complications. The independent variables were age, body mass index (BMI), sex, history of depression and presence of more than one cardiovascular risk factor (CVRF). RESULTS: Following LGBP, 11% of the results was classified as excellent, 54% as very good, 25% as good and 9% as fair (median follow-up period: 17 months, 7-37). The best scores were found among younger patients. The EWL (mean: 55.4 ± 16.6%) was higher in patients with lower BMI and with no more than one cardiovascular risk factor. We obtained rates of resolution of CVRF of 43.7 to 68.7%, complication rates < 10% and improvement of quality of life. CONCLUSIONS: We believe that, following LGBP in morbidly obese patients, when EWL, improvement in comorbidities and quality of life as well as complications are jointly assessed, the best results are obtained in younger patients.

Clinical and polygraphic evolution of sleep-related breathing disorders in adolescents.

It has been suggested that sleep-related breathing disorders (SRBD) involve a continuum that develops over the course of life. If modifiable factors could be identified, the progression of SRBD could perhaps be addressed early in life. Although some studies have looked at the evolution of SRBD in pre-pubertal children, very few studies obtained data in adolescents. Anthropometric, clinical and polygraphic variables were collected during a 4-yr follow-up study among 148 normal adolescents after initial cross-sectional analysis. From a total of 267 adolescents studied at baseline (mean+/-sd age 14.3+/-2.1 yrs), 148 (55.4%) were followed up for 4 yrs. During follow-up, there were no significant changes in snoring and polygraphic parameters. However, a tendency toward weight gain with centrally distributed fat was observed. Habitual snorers had a significantly higher body mass index and more centrally distributed fat than nonsnorers. Males had a higher snoring prevalence and a higher number of respiratory events than females. Snoring at baseline, male sex and poor academic performance were significant predictors of snoring at follow-up. Snoring tends to persist during adolescence and male sex acts as a risk factor. A relationship between snoring and academic performance was observed. These findings may have implications for long-term management of sleep-related breathing disorders.

Efficacy of low-dose lansoprazole in the treatment of non-erosive gastrooesophageal reflux disease. Influence of infection by Helicobacter pylori.

INTRODUCTION: Proton pump inhibitors (PPIs) are the most effective drugs to cure peptic esophagitis and control the symptoms of gastroesophageal reflux disease (GERD). In most patients with GERD esophagitis is not detected by endoscopy, which represents GERD with a negative endoscopy or non-erosive reflux disease (NERD). The influence of infection by H. pylori in the evolution of GERD is controversial since a protective action is identified by some studies, but not all. We conducted a clinical trial to assess the efficacy of lansoprazole 15 mg/day in the initial control of NERD symptoms, and as a secondary endpoint the impact of H. pylori infection on response to treatment. PATIENTS AND METHODS: A pilot, single-center clinical trial was conducted--single-blind regarding the experimental medication (unknown to patients), and double-blind regarding the information concerning H. pylori infection. Sixty (60) patients with NERD were initially included, who had suffered from daytime or nocturnal heartburn for 1-2 days in each of the last two weeks. Nine patients were excluded for failing to comply with the study protocol. The 51 remaining patients, 35 women and 16 men, with a mean age of 49 years, comprised the per protocol analysis population. Patients received treatment for two weeks with a capsule of the study medication (15 mg/day of lansoprazole), with daily controls on the presence and severity of daytime and nocturnal heartburn. Treatment was considered effective when, upon completion, patients referred a maximum of one episode of mild heartburn as defined in the protocol, or answered the following question in the affirmative: "Does the medication you are receiving satisfactorily control the symptoms of your disease?". During diagnostic endoscopy we obtained biopsies of the gastric body and antrum to investigate infection by H. pylori by means of a urease test. Treatment efficacy was assessed with no patients or doctors responsible for the study being aware of urease test results. RESULTS: 41 patients (80.3%) reported that treatment had satisfactorily controlled their symptoms, and 34 patients (66.6%) had a maximum of one episode of mild heartburn in the last week. Forty-two (42) patients (82.3%) had infection by H. pylori. No significant differences were observed in the response to treatment between patients with or without H. pylori infection. CONCLUSIONS: With the limitations of a pilot study, these results suggest that lansoprazole 15 mg/day is an effective treatment in the control of NERD symptoms, that it may be a good initial therapeutic strategy, and that, according to data available, H. pylori infection has no significant effect on the response to treatment.

Dissipation of polycyclic aromatic hydrocarbons from soil added with manure or vermicompost.

The dissipation of three PAHs, i.e., 500 mg phenanthrene kg(-1) soil, 350 mg anthracene kg(-1) soil and 150 mg benzo(a)pyrene kg(-1) soil, was investigated in soil from Acolman (México) added with cow manure or vermicompost while production of CO(2) and inorganic N was monitored. At day 0, recovery of added phenanthrene was 95%, anthracene 96% and benzo(a)pyrene 100% in sterilized soil and concentrations did not change significantly in sterilized soil over time. Application of organic material did not affect the concentration of phenanthrene and anthracene, which decreased sharply in the unsterilized soil in the first weeks of the incubation. Less than 3% of the added phenanthrene was detected after 100 days and less than 8.5% of the added anthracene (mean of the two experiments). The decrease in concentration of benzo(a)pyrene (BaP) was not fast as that of phenathrene and anthracene, and 22% was extractable from soil still after 100days. It was concluded that addition of farm yard manure (FYM) and vermicompost only had an effect on the initial dissipation of phenanthrene, anthracene and benzo(a)pyrene in soil of Acolman.

Eficacia de lansoprazol a dosis bajas en el tratamiento de la enfermedad por reflujo gastroesofágico no erosiva. Influencia de la infección por Helicobacter pylori / Efficacy of low-dose lansoprazole in the treatment of non-erosive gastrooesophageal reflux disease. Influence of infection by Helicobacter pylori

Introducción: los inhibidores de la bomba de protones (IBP) son los fármacos más eficaces en la curación de la esofagítis péptica y en el control de los síntomas de la enfermedad por reflujo gastroesofágico (ERGE). En la mayoría de los pacientes con ERGE no se detecta esofagitis al practicarse endoscopia presentando una ERGE con endoscopia negativa o no erosiva (ERNE). La influencia de la infección H. pylori en la evolución de la ERGE es controvertida, ya que mientras que unos estudios le asignan una acción protectora, otros se la niegan. Hemos realizado un ensayo clínico para valorar la eficacia de lansoprazol 15 mg/día en el control inicial de los síntomas de la ERNE y, como objetivo secundario, la influencia de la infección H. pylori en la respuesta al tratamiento. Pacientes y métodos: se realiza un ensayo clínico piloto, unicéntrico, simple ciego en cuanto a la medicación experimental, no conocida por los pacientes, y doble ciego en cuanto a la información de la infección por H. pylori. Se incluyeron inicialmente 60 pacientes con ERNE que presentaban al menos dos días con pirosis diurna o nocturna en cada una de las dos últimas semanas. Se excluyeron 9 pacientes por incumplimiento del protocolo del estudio. Los 51 pacientes restantes, 35 mujeres y 16 hombres, con edad media de 49 años, constituyeron la población de análisis por protocolo. Los pacientes recibieron tratamiento durante dos semanas con una cápsula de la medicación de estudio (15 mg/día de lansoprazol), realizándose en este tiempo un seguimiento diario de la presencia e intensidad de la pirosis diurna y nocturna. Se consideró que el tratamiento era eficaz cuando a su finalización los pacientes referían haber presentado como máximo un episodio de pirosis de intensidad leve, según definición del protocolo, o bien respondían afirmativamente a la siguiente pregunta: “¿la medicación que recibe le controla de forma satisfactoria los síntomas de su enfermedad?”. Durante la endoscopia diagnóstica se obtuvieron biopsias de cuerpo y antro gástrico para investigar, mediante test de la ureasa, la infección por H. pylori. Se valoró la eficacia del tratamiento sin conocerse por los pacientes y médicos responsables del estudio los resultados de los test de ureasa. Resultados: cuarenta y un pacientes (80,3%) referían que el tratamiento les controlaba de forma satisfactoria la sintomatología y 34 pacientes (66,6%) habían presentado como máximo un episodio de pirosis de intensidad leve en la última semana. Cuarenta y dos pacientes (82,3%) presentaban infección por H. pylori. No se observaron diferencias significativas en la respuesta al tratamiento en los pacientes con o sin infección por H. pylori. Conclusiones: con las limitaciones propias de un estudio piloto, estos resultados, orientan a que lansoprazol 15 mg/día es un tratamiento eficaz en el control de la sintomatología de la ERNE, pudiendo ser una buena estrategia terapéutica inicial y que, con los datos disponibles, la infección por H. pylori no influye de forma significativa en la respuesta al tratamiento

Introduction: proton pump inhibitors (PPIs) are the most effective drugs to cure peptic esophagitis and control the symptoms of gastroesophageal reflux disease (GERD). In most patients with GERD esophagitis is not detected by endoscopy, which represents GERD with a negative endoscopy or non-erosive reflux disease (NERD). The influence of infection by H. pylori in the evolution of GERD is controversial since a protective action is identified by some studies, but not all. We conducted a clinical trial to assess the efficacy of lansoprazole 15 mg/day in the initial control of NERD symptoms, and as a secondary endpoint the impact of H. pylori infection on response to treatment. Patients and methods: a pilot, single-center clinical trial was conducted –single-blind regarding the experimental medication (unknown to patients), and double-blind regarding the information concerning H. pylori infection. Sixty (60) patients with NERD were initially included, who had suffered from daytime or nocturnal heartburn for 1-2 days in each of the last two weeks. Nine patients were excluded for failing to comply with the study protocol. The 51 remaining patients, 35 women and 16 men, with a mean age of 49 years, comprised the per protocol analysis population. Patients received treatment for two weeks with a capsule of the study medication (15 mg/day of lansoprazole), with daily controls on the presence and severity of daytime and nocturnal heartburn. Treatment was considered effective when, upon completion, patients referred a maximum of one episode of mild heartburn as defined in the protocol, or answered the following question in the affirmative: “Does the medication you are receiving satisfactorily control the symptoms of your disease?”. During diagnostic endoscopy we obtained biopsies of the gastric body and antrum to investigate infection by H. pylori by means of a urease test. Treatment efficacy was assessed with no patients or doctors responsible for the study being aware of urease test results. Results: 41 patients (80.3%) reported that treatment had satisfactorily controlled their symptoms, and 34 patients (66.6%) had a maximum of one episode of mild heartburn in the last week. Forty-two (42) patients (82.3%) had infection by H. pylori. No significant differences were observed in the response to treatment between patients with or without H. pylori infection. Conclusions: with the limitations of a pilot study, these results suggest that lansoprazole 15 mg/day is an effective treatment in the control of NERD symptoms, that it may be a good initial therapeutic strategy, and that, according to data available, H. pylori infection has no significant effect on the response to treatment

Diagnosis of Helicobacter pylori infection using urease rapid test in patients with bleeding duodenal ulcer: influence of endoscopic signs and simultaneous corporal and antral biopsies.

INTRODUCTION: The sensitivity of invasive diagnostic methods for Helicobacter pylori (H. pylori) infection, particularly of urease rapid test, is decreased in cases of gastroduodenal ulcer and upper gastrointestinal bleeding. OBJECTIVES: To assess the influence of blood in the stomach or recent bleeding endoscopic signs in the diagnostic sensitivity of urease rapid test among patients with bleeding duodenal ulcer, as well as the influence of simultaneously collecting corporal and antral biopsy samples. PATIENTS AND METHODS: 120 patients, 85 male and 35 female, with an average age of 62 (18-88) years, who were admitted to our Hospital due to bleeding duodenal ulcer and who received an endoscopic diagnosis within 24 hours of admission were included. None of the patients had been under treatment with non-steroideal antiinflammatory drugs, proton-pump inhibitors or antimicrobial drugs in the two weeks prior to the bleeding event, and none had received eradicating therapy for H. pylori. In this group of selected patients an H. pylori infection rate nearing 100% was assumed. H. pylori infection was ruled out using antral biopsy (69 cases) or both antral and fundic biopsies (51 cases) for urease rapid testing (Jatrox-H.p.-Test). Patients were classified in three groups according to their endoscopic bleeding signs: a) presence of blood in the stomach or recent bleeding ulcer (21 cases); b) ulcer showing non-recent bleeding signs (38 cases); and c) ulcer without bleeding signs (61 cases). The sensitivity of the urease rapid test was compared between patient groups. Similarly, urease test results with an antral biopsy sample were compared in 100 patients with non-bleeding duodenal ulcer. RESULTS: Urease test was positive in 93% of patients with non-bleeding duodenal ulcer, and in 83% of patients with upper gastrointestinal bleeding, which reached statistical significance (p = 0.019). This test was positive in 82.6% of patients with an antral biopsy, and in 82.3% of patients with combined antral and fundic biopsies. In group A, urease test was positive in 90.5% of patients; in group B, it was positive in 89.5% of patients, and in group C, the test turned positive in 75.4% of patients. Statistical differences were only reached when patients in group C were compared to patients in groups A and B together (p = 0.037). CONCLUSIONS: 1. The presence of either blood in the stomach or recent bleeding endoscopic signs appeared not to be the conditioning factor for the decreased sensitivity of urease test among patients with bleeding duodenal ulcer. 2. The decreased sensitivity of this test in patients with upper gastrointestinal bleeding is more evident during the resolution stage, and it does not seem to occur because of H. pylori migration from the antrum to the corporal gastric region.

Diagnosis of Helicobacter pylori infection in patients with bleeding ulcer disease: rapid urease test and histology.

INTRODUCTION: The endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests. AIMS: To evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori) in patients with bleeding peptic ulcer. PATIENTS AND METHODS: We included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88), with upper gastrointestinal bleeding secondary to duodenal ulcer (115) or gastric ulcer (58), diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin) and one or two antral biopsies for rapid urease test (Jatrox-H.p.-test). In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection. RESULTS: 152 patients (88%) showed H. pylori infection, 104 patients (90%) with duodenal ulcer and 48 patients (83%) with gastric ulcer. In all 119 cases (78%) were diagnosed by the urease test and 112 cases (74%) by histology. Both methods were used to diagnose 134 of 152 cases (88%) (p < 0.05), these being positive in 97 cases and negative in 39 cases. In 18 of these 39 cases, the breath test was positive. CONCLUSIONS: Histology and urease test have similar diagnostic values for the identification of H. pylori in patients with bleeding peptic ulcer. Due to its rapid results, the urease test should be the method of choice. However, additional biopsies should be performed, and, when negative, a histological study should be carried out, since a combination of both methods allows a more precise diagnosis.

Valor de la serología (IgG-ELISA) como método diagnóstico alternativo de infección por Helicobacter pylori en pacientes con hemorragia digestiva por úlcera gastroduodenal / The effectiveness of (IgG-ELISA) serology as an alternative diagnostic method for detecting Helicobacter pylori infection in patients with gastro-intestinal bleeding due to gas tro-duodenal ulcer

Objetivos: determinar la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la serología (IgG sérica-ELISA) como método diagnóstico alternativo de infección por Helicobacter pylori en pacientes con úlcera péptica gastroduodenal y hemorragia digestiva. El diagnóstico de la infección por He licobacter pylori en estos pacientes es dificultoso por la baja sensibilidad de los tests invasivos y la necesidad de suspender el tratamiento con inhibidores de la bomba de protones para realizar un test del aliento con urea marcada con 13C o la detección de antígenos de Helicobacter pylori en heces.Pacientes y métodos: incluimos 214 pacientes (164 varones y 50 mujeres), con edad media de 58ñ15 años, que ingresaron por hemorragia digestiva alta por úlcera péptica gastroduodenal. Investigamos la presencia de Helicobacter pylori mediante biopsias gástricas (test rápido de la ureasa, histología y/o cultivo) y por test del aliento con urea marcada con 13C. Se realizó serología frente a Helicobacter pylori con método ELISA (Pyloriset EIA-G de Orion Diagnóstica). Se consideró criterio de infección por He licobacter pylori la positividad de cualquier método invasivo o del test del aliento y criterio de no infección la negatividad de todos los métodos invasivos realizados y del test de aliento con urea marcada con 13C. Calculamos la sensibilidad, especificidad, el valor predictivo positivo y el valor predictivo negativo de la serología en la serie global y en diferentes subgrupos de pacientes según la edad >60 y 60 años (n=105), en el grupo de úlcera duodenal (n=141) respecto al grupo de úlcera gástrica (n=59) y en el grupo con antecedentes de úlcera péptica gastroduodenal (n=92) respecto al grupo sin estos antecedentes (n=122), aunque en ningún caso se alcanzó significación estadística. Conclusiones: la serología IgG (ELISA) presenta una baja especificidad y un bajo valor predictivo negativo en el diagnóstico de infección por Helicobacter pylori en los pacientes con hemorragia digestiva por úlcera péptica gastroduodenal. El valor diagnóstico de la serología no mejora de forma significativa al considerar la edad, la exposición reciente a antiinflamatorios no esteroideos, el tipo de lesión endoscópica o los antecedentes de úlcera péptica gastroduodenal. Podemos considerar que la serología no es un buen método diagnóstico de infección por Helicobacter pylori en pacientes con hemorragia digestiva por úlcera gastroduodenal. (AU)

The effectiveness of (IgG-ELISA) serology as an alternative diagnostic method for detecting Helicobacter pylori infection in patients with gastro-intestinal bleeding due to gastro-duodenal ulcer.

OBJECTIVES: To establish the sensitivity, specificity, positive predictive value and negative predictive value of serology (IgG ELISA) as an alternative diagnostic method for Helicobacter pylori infection in patients with gastro-duodenal peptic ulcer and digestive hemorrhage. The diagnosis of Helicobacter pylori infection in these patients is difficult due to the low sensitivity of invasive tests and the need to discontinue treatment with proton pump inhibitors to perform a breath test with urea 13C or the detection of Helicobacter pylori antigens in feces. PATIENTS AND METHODS: We included 214 patients (164 men and 50 women) with an average age of 58 +/- 15 years, who were admitted to hospital due to upper gastro-intestinal bleeding caused by a gastro-duodenal peptic ulcer. The presence of Helicobacter pylori was established by means of gastric biopsy (fast urease test histology and/or culture) and a breath test with 13C-labeled urea. Serology was performed with the ELISA method (Pyloriset EIA-G by Orion Diagnostica). Positive Helicobacter pylori infection was accepted with any positive invasive method or breath test, and no infection was established if all invasive tests performed and the breath test with 13C-labeled urea were negative. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of serology in the global series and in different subgroups of patients according to age (> 60 and < 40 years), recent exposure to non-steroidal anti-inflammatory drugs, type of endoscopic wound and history of gastro-duodenal peptic ulcer. RESULTS: 192 patients (89.7%) showed infection due to Helicobacter pylori. In the global series (n = 214) we obtained a sensitivity, specificity, positive predictive value and negative predictive value of 87.5, 54.5, 94.3 and 33.3%, respectively. Specificity was greater in the group not exposed to non-steroidal anti-inflammatory drugs (n = 110) as compared to the exposed group (n = 104), in the < 40 year old group (n = 28) with respect to the > 60 years group (n = 105), in the duodenal ulcer group (n = 141) with respect to the gastric ulcer group (n = 59), and in the group with a history of gastro-duodenal peptic ulcers (n = 92) as compared to the group without any of these past events (n = 122); nevertheless, no significant statistics were reached. CONCLUSIONS: IgG (ELISA) serology shows low specificity and a low negative predictive value in the diagnosis of Helicobacter pylori infection in patients with gastro-intestinal bleeding due to gastro-duodenal peptic ulcer. The diagnostic value of serology did not improve significantly when age, recent exposure to non-steroidal anti-inflammatory drugs, type of endoscopic wound or history of gastro-duodenal peptic ulcer was taken into consideration. We may consider that serology is not a good diagnostic method for the detection of Helicobacter pylori in patients with digestive hemorrhage caused by gastro-duodenal ulcer.

[Upper gastrointestinal tract injury caused by ingestion of caustic substances]. / Lesiones del tracto digestivo superior causadas por la ingestión de cáusticos.

BACKGROUND: To determine the distribution, extension and severity of injuries produced by the ingestion of caustic substances in the upper gastrointestinal tract, and to assess the relationship of these factors with the type of caustic substance ingested, whether intake was accidental or deliberate and the appearance of strictures or death. PATIENTS AND METHOD: Between 1993 and 1999, 138 patients (74 males and 84 females) who underwent upper gastrointestinal endoscopy in our unit within the first 24 hours after ingestion of caustic substances were included in the study. Mean age was 47 years (14-97 years). The severity of caustic injury was evaluated using the classification of Showkat et al. RESULTS: The type of caustic substance ingested was as follows: lye in 84 patients (53%), nitric acid in 21 (13%), different caustic mixtures in 43 (27%) and unknown in 10 patients (6%). Lesions were grade I in 51 patients(32%), grade II in 33 (21%) and grade III in 20 (13%). No lesions were seen in 54 patients (34%). Of the 158 patients, gastric injury was found in 91 (57.5%), esophageal burn in 72 (45.5%) and duodenal injury in 28 (18%). Ingestion was accidental in 80 patients (51%) and voluntary in 62 (39%); the reasons for ingestion were unclear in 16 patients (10%). Voluntary ingestion and acid use were associated with greater severity of lesions (p < 0.0005). Eight patients (5.0%) died, 10 patients (6.3%) required emergency surgery, and 7 (4.4%) developed esophageal-gastric strictures that required surgery or endoscopic treatment. CONCLUSIONS: The most common type of caustic substance ingested was lye. In 66% of the patients, lesions were absent or superficial. The more severe injuries, producing strictures and higher mortality, were related to voluntary and nitric acid ingestion. The part of the digestive tract most frequently affected after lye and acid ingestion was the stomach.

Sleep-related breathing disorders in adolescents aged 12 to 16 years : clinical and polygraphic findings.

STUDY OBJECTIVES: To determine the frequency, symptoms, and polygraphic features of sleep-related breathing disorders (SRBD) in adolescents aged 12 to 16 years. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in the city of Seville, SPAIN: PARTICIPANTS: A general population sample of adolescents (n = 101; mean [+/- SD] age, 13.2 +/- 0.8 years). INTERVENTIONS: An 82-item questionnaire regarding anthropometric data and nocturnal and daytime symptoms suggestive of SRBD was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" in the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent an overnight cardiorespiratory polygraphy at home. RESULTS: Twenty-nine percent of the subjects were snorers. Excessive daytime sleepiness was present in 14% of subjects, and sleep apnea was present in 3%. Polygraphy showed a respiratory disturbance index > or = 10 in 18 subjects (17.8%), but concurrent symptoms highly suggestive of SRBD were found in only 2 subjects (1.9%). Snorers had higher waist-to-hip ratios and a higher frequency of witnessed apnea or labored breathing as well as higher values of respiratory events as compared with nonsnorers. However, oximetry data were similar in both groups. CONCLUSIONS: In a nonselected group of adolescents aged 12 to 16 years, the frequency of symptoms potentially associated with SRBD was similar to that reported for younger children. Snoring was associated with a higher occurrence of other nocturnal symptoms, a more central pattern of body fat distribution, and a higher respiratory disturbance index as compared with nonsnorers. Although polygraphic abnormalities were mild, two cases of probable SRBD were found with a prevalence rate of 1.9%.