Daniel Urbain

A biodegradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child.

Children who ingest a caustic product with resultant corrosive esophagitis comprise a heterogeneous group of patients in terms of the offending agent, the location of the burn, and the degree of damage. Today, there is no optimal standardized approach. We report a case of successful treatment of a child with an esophageal stenosis after caustic ingestion with a self-expanding and biodegradable esophageal stent.

Heartburn in Belgium: prevalence, impact on daily life, and utilization of medical resources

Background Gastro-oesophageal reflux disease (GORD) is a frequently occurring disease that may be considered a public health issue, particularly in developed countries. The specificity of heartburn for the diagnosis of GORD is good. Our aim was to define the prevalence of heartburn in Belgium, characterizing both its impact on everyday life and the ensuing use of medical resources. Methods Two thousand people living in Belgium, selected randomly after stratification, were interviewed face to face. The main question in the questionnaire used in this interview concerned the presence over the previous 12 months of a burning sensation in the epigastric and/or retrosternal region. This was followed by 21 secondary questions on the characteristics of the population studied, the impact of heartburn on everyday life, and the medical resources used. Results Twenty-eight per cent of the population interviewed reported heartburn. This symptom was present at least once a week in 42% of sufferers. Heartburn was more frequent in women than men (P < 0.05) and was not distributed uniformly throughout the various regions of the country (P < 0.05). Seventy-seven per cent of the people with heartburn found that it had a significantly negative impact on their daily lives (in 27%, this effect was strong). Heartburn associated with a substantial negative impact on daily life was characterized by a higher frequency of symptoms (P < 0.0001), a longer duration of the problem (P = 0.006), and the presence of pain (P < 0.0001) and anxiety (P < 0.0001). Fifty-six per cent of individuals with heartburn had already sought medical advice, 45% had undergone an upper-gastrointestinal tract endoscopy, and 59% were taking medications. Among patients complaining that heartburn had a substantial negative effect on their everyday lives, 21.6% had not sought medical advice and 22.2% did not take any medication. Conclusion Heartburn is very frequent in Belgium and is associated with a considerable negative impact on everyday life. It also generates a significant use of medical resources. However, among the patients complaining of a substantial negative effect on their daily lives, one-fifth (which would represent 1.5% of the Belgian population) seemed to lack appropriate care.

Dyspeptic symptoms in the general population: a factor and cluster analysis of symptom groupings.

Abstract  Both dyspeptic and gastro‐oesophageal reflux‐like symptoms are frequent in the general population, but their degree of overlap is unknown. In severe functional dyspepsia (FD), symptoms are organized in factors associated with pathophysiological mechanisms. The aims of this study were: (i) to assess the prevalence of dyspeptic symptoms with and without overlapping reflux symptoms in the general population and their impact on daily life and on healthcare utilization; and (ii) to compare symptom groupings in the general population to FD patients. A total of 2025 subjects, representative of the Belgian general population, were used in this study. The subjects were submitted to a questionnaire with validated questions on their dyspeptic and reflux symptoms and with evaluators of impact on daily life and use of healthcare resources. Significant dyspeptic symptoms were found in 417 (20.6%). Overlapping reflux symptoms were present in 141 (33.8%). In this group, symptoms were more frequent and more severe. Dyspeptic symptoms induced weight loss (12.7%) and absenteeism (12.4%), affected daily life (61.2%) and generated use of healthcare resources, such as medical consultations (61.4%) and medication (70.9%). Factor analysis revealed a three‐component structure with factor 1 including fullness, bloating and early satiety, factor 2 including nausea and vomiting and factor 3 including discomfort, pain, belching and reflux. If forced in a four‐factor model, the analysis separates belching as independent factor. Dyspeptic symptoms are frequent in the general population, with overlapping reflux symptoms and increased symptom burden in about a third.

Expression of somatostatin receptors in normal and cirrhotic human liver and in hepatocellular carcinoma

Background: Somatostatin analogues have been used with conflicting results to treat advanced hepatocellular carcinoma (HCC). The aim of this study was to investigate expression of somatostatin receptor (SSTR) subtypes in human liver, and to examine the effect of selective SSTR agonists on proliferation, apoptosis, and migration of hepatoma cells (HepG2, HuH7) and hepatic stellate cells (HSCs). Methods: Expression of SSTRs in cell lines, normal and cirrhotic liver, and HCC was examined by immunohistochemistry and reverse transcription-polymerase chain reaction. Effects of SSTR agonists on proliferation and apoptosis of tumour cells and HSCs were assessed by the 5-bromo-2′ deoxyuridine and TUNEL methods, respectively. The influence of SSTR agonists on migration was investigated using Boyden chambers. Results: In normal liver, both hepatocytes and HSCs were negative for all five SSTRs. Cirrhotic liver and HCC as well as cultured hepatoma cells and HSCs expressed all five SSTRs, both at the protein and mRNA levels, except for HuH7 cells which did not immunoreact with SSTR3. None of the agonists influenced proliferation or apoptosis. However, compared with untreated cells, L-797,591, an SSTR1 agonist, reduced migration of HepG2, HuH7, and HSCs significantly to 88 (7)% (p<0.05), 83 (11)% (p<0.05), and 67 (13)% (p<0.01), respectively. Conclusions: Cirrhotic liver and HCC express SSTRs. Although the somatostatin analogues used in this study did not affect proliferation and apoptosis, stimulation of SSTR1 may decrease invasiveness of HCC by reducing migration of hepatoma cells and/or HSCs. Clinical trials evaluating somatostatin analogues for the treatment of HCC should take these findings into account.

Intragastric Balloons for Preoperative Weight Reduction

Background: If medical treatment of obesity fails and if surgical gastroplasty is not indicated, insertion of an intragastric balloon may represent an intermediate modality. Methods: Two patients are reported in whom a balloon was placed for weight reduction before elective surgery: 1) A 53-year-old woman with a BMI of 41.3 kg/m2 lost 18 kg in 6 months and then underwent surgical repair of a huge incisional hernia; 2) A 58- year-old woman with a BMI of 35.8 kg/m2 had total hip arthroplasty after losing 15.5 kg in 5 months. Results: The uneventful postoperative recovery in both patients was thought to be positively influenced by their preoperative weight loss. Conclusion: In morbidly obese patients, intragastric balloon placement may contribute to preoperative weight reduction before elective surgery.

Metastases to the thyroid gland-a report of six cases.

The association of an asymptomatic mass, normal thyroid function, and a cold nodule can occur months to years after a primary cancer. Work-up should include ruling out other metastases and fine-needle aspiration cytology. We report six cases of secondary thyroid cancer. Two of the patients in our series presented with hyperthyroidism, which may be due to invasion and disruption of thyroid follicles.

Regulation of sinusoidal perfusion in portal hypertension.

Portal hypertension, a major complication of cirrhosis, is caused by both increased portal blood flow and augmented intrahepatic vascular resistance. Even though the latter is primarily caused by anatomical changes, it has become clear that dynamic factors contribute to the increased hepatic vascular resistance. The hepatic sinusoid is the narrowest vascular structure within the liver and is the principal site of blood flow regulation. The anatomical location of hepatic stellate cells, which embrace the sinusoids, provides a favorable arrangement for sinusoidal constriction, and for control of sinusoidal vascular tone and blood flow. Hepatic stellate cells possess the essential contractile apparatus for cell contraction and relaxation. Moreover, the mechanisms of stellate cell contraction are better understood, and many substances which influence contractility have been identified, providing a rationale and opportunity for targeting these cells in the treatment of portal hypertension in cirrhosis. Anat Rec, 291:693–698, 2008.

Prediction of response to neoadjuvant radiotherapy in patients with locally advanced rectal cancer by means of sequential 18FDG-PET.

PURPOSE Morphologic imaging techniques perform poorly in assessing the response to preoperative radiotherapy (RT), mainly because of desmoplastic reactions. The aim of this study was to investigate the potential of sequential 18-fluoro-2-deoxy-d-glucose (18FDG-PET) in assessing the response of rectal cancer to neoadjuvant RT and to determine which parameters can be used as surrogate markers for histopathologic response. METHODS AND MATERIALS 18FDG-PET scans were acquired before and during the 5th week after the end of RT. Tracer uptake was assessed semiquantitatively using standardized uptake values (SUV). The percentage differences (%Δ) between pre- and post-RT scans in SUV(max), SUV(mean), metabolic volume (MV), and total glycolytic volume (tGV) were calculated. RESULTS Forty-five consecutive patients with histologically confirmed rectal adenocarcinoma were enrolled. After neoadjuvant RT, 20 of the 45 patients were classified as histopathologic responders and 25 as non-responders. Intense 18F-FDG uptake was seen in all tumors before neoadjuvant RT (average SUV(max) 12.9 ± 6.0). When patients were classified as histologic responders and nonresponders, significant differences in %ΔSUV(max) (55.8% vs. 37.4%, p = 0.023) and %ΔSUV(mean) (40.1% vs. 21.0%, p = 0.001) were observed between the two groups. For %ΔMV and %ΔtGV, decreases were more prominent in responders but were not significantly different from those in nonresponders. As demonstrated by receiver operating characteristic analysis, %ΔSUV(mean) was a more powerful discriminator than was %ΔSUV(max). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for optimal threshold of %ΔSUV(mean) (24.5%) were 80%, 72%, 76%, 70%, and 82% respectively. CONCLUSION Sequential 18FDG-PET allows assessment of the response to preoperative RT. Both %ΔSUV(mean) and %ΔSUV(max) correlate with histopathologic response and can be used to evaluate and compare the effectiveness of different neoadjuvant treatment strategies. The maximum accuracy figures and the positive predictive value figures for both Δ%SUV(mean) and Δ%SUV(max) are, however, too low to justify modification of the standard treatment protocol of an individual patient.

Efficacy of oral fluconazole in the treatment of AIDS associated oesophageal candidiasis

To assess the efficacy and tolerance of fluconazole in the treatment of oesophageal candidiasis, 47 AIDS patients with this infection were enrolled in an open prospective study using fluconazole 100 mg given orally once daily. Clinical cure was obtained in all of 41 evaluable patients, with confirmation of cure in all of 31 patients who underwent post-treatment oesophagoscopy. Forty patients were followed up for at least 30 days; none suffered a relapse of oesophagitis but seven had a recurrence of stomatitis which was effectively treated with fluconazole. Fluconazole was well tolerated. Nausea was noted in three patients one of whom interrupted therapy. Transient mild elevation of ALT/AST was noted in five of 41 patients (12 %). Fluconazole appears to be a safe and effective agent for oral therapy of oesophageal candidiasis associated with AIDS.

Somatostatin at nanomolar concentration reduces collagen I and III synthesis by, but not proliferation of activated rat hepatic stellate cells

Previous studies have shown antifibrotic effects of somatostatin. Since hepatic stellate cells (HSC) express somatostatin receptors and play a key role in hepatic fibrogenesis, we investigated the in vitro antifibrotic effect of somatostatin on rat HSC. At day 12 after isolation, cells were exposed to different concentrations of somatostatin (10−6–10−9 mol l−1). mRNA expression of collagen types I and III, and of smooth muscle α‐actin (α‐SMA) was analysed by Northern blotting. At 10−9 mol l−1, somatostatin significantly reduced mRNA expression of collagen I (72.3±10.7%; 95% confidence interval (95% CI): 45.5–99.0), collagen III (79.0±4.5%; 95% CI: 67.6–90.4) and α‐SMA (65.7±5.9%; 95% CI: 51.1–80.2), as compared to control normalized at 100%. These results were confirmed by quantitative RT–PCR. Cycloheximide experiments indicated that somatostatin has no direct transcriptional effect. Using immunoprecipitation, we demonstrated that somatostatin also decreased de novo synthesis of collagen I (73±10%; 95% CI: 48–98%), collagen III (65±13%; 95% CI: 33–97%) and α‐SMA (47±9%; 95% CI: 25–69%). Remarkably, at higher concentrations, somatostatin did not suppress collagen mRNA expression nor de novo protein synthesis. We ascribe this observation to desensitization of the cells for somatostatin. Cell proliferation, as measured by 5‐bromo‐2′‐deoxyuridine labelling, was not altered by somatostatin. No significant effect on the intermediate and actin cytoskeleton were detected by immunohistochemistry and Western blotting. Our findings imply that in vivo antifibrotic effects of somatostatin could result partially from a direct action of somatostatin on HSC, but other, in vivo effects are probably also involved.