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PubMed2005

Beyond heartburn: a systematic review of the extra-oesophageal spectrum of reflux-induced disease.

BACKGROUND: Gastro-oesophageal reflux disease (GORD) is a chronic condition affecting up to one-quarter of the Western population. GORD is characterized by heartburn and acid regurgitation, but is reported to be associated with a spectrum of extra-oesophageal symptoms. OBJECTIVE: The aim of this systematic review was to critically evaluate postulated extra-oesophageal symptoms of GORD. METHODS: Extra-oesophageal symptoms were identified from population-based studies evaluating their association with GORD (either defined as heartburn and/or acid regurgitation, or diagnosed in general practice). The response of these symptoms to acid-suppressive therapy was investigated using randomized, double-blind, placebo-controlled studies. Pathogenic mechanisms were evaluated using clinical and preclinical studies. RESULTS: An association between GORD and symptoms or a diagnosis of chest pain/angina, cough, sinusitis and gall-bladder disease was evident from three eligible population-based studies of GORD. Randomized placebo-controlled studies (n=20) showed that acid-suppressive therapy provides symptomatic relief of chest pain, asthma and, potentially, chronic cough and laryngitis. Mechanistic models, based on direct physical damage by refluxate or vagally mediated reflexes, support a causal role for GORD in chest pain and respiratory symptoms, but not in gall-bladder disease. CONCLUSION: GORD is likely to play a causal role in chest pain and possibly asthma, chronic cough and laryngitis. Further investigation is desirable, particularly for other potential extra-oesophageal manifestations of GORD such as chronic obstructive pulmonary disease, sinusitis, bronchitis and otitis. Acid-suppressive therapy is likely to benefit patients with non-cardiac chest pain, but further placebo-controlled studies are needed for other symptoms comprising the extra-oesophageal spectrum of GORD.

Asthma↗
PubMed1992

Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh.

Morphological changes of gall bladder were studied in 415 cholecystectomy specimens. There was a preponderance of females (male to female ratio--1:6.5). The mean age of the cases was 43.6 years. Most of the cases (63.4%) were in the 4th and 5th decades of life. The average duration of illness was 2.8 years. Associated cholelithiasis was present in 85.3% cases. Gall-stones were of mixed variety in 78.2% cases, cholesterol type in 15.3% cases and both types were present in 6.5% cases. Chronic cholecystitis was the main histological diagnosis (50.8%). Other lesions observed were adenomyomatosis (8.2%), adenomatous hyperplasia (10.1%), granulomatous cholecystitis (4.1%), cholesterosis (2.7%), acute cholecystitis (4.1%), acute on chronic infection (10.8%), sub-acute cholecystitis (2.4%) and carcinoma gall bladder (6.8%). The frequency of Rokitansky-Aschoff's sinuses was closely related with the degree of inflammatory response. In 13 (6.2%) cases the diagnosis of chronic follicular cholecystitis was made. All the cases of cholesterosis were multiparous females and of younger age. Of the malignant lesions, adenocarcinoma was the commonest (96.4%).

Adult↗
PubMed1994

Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group.

Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear. A prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland over a two year period was carried out to attempt to assess this new procedure. A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy submitted prospective data from September 1990-1992. A total of 2285 cholecystectomies were audited (a completed data collection rate of 99%). Laparoscopic cholecystectomy was attempted in 1683 (74%) patients and completed in 1448 patients (median conversion rate to the open procedure 17%). The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes (range 30-330) and overall hospital stay three days (1-33). There were nine deaths (0.5%) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure. In the laparoscopic cholecystectomy group there were 99 complications (5.9%), 53 (3%) of these were major requiring further invasive intervention. Forty patients (2.4%) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries. There were 11 (0.7%) bile duct injuries in the laparoscopic cholecystectomy series, five were noted during the initial procedure and six were recognised later resulting from jaundice or bile leaks. Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies. In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease. Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy, the bile duct injury rate is higher.

Adolescent↗
PubMed1978

Immunoperoxidase staining of carcinoembryonic antigen in urinary bladder cancer.

An immunoperoxidase study of the presence of carcinoembryonic antigen (CEA) in primary cancers of the urinary bladder, metastases to the bladder, non-malignant diseased bladder, and normal bladder tissues revealed that approximately 10 percent of the urothelial carcinomas (transitional cell and squamous cell types) contained detectable quantities of this antigen. The other tissues were devoid of stainable CEA. It thus appears that the incidence of positive CEA by immunoperoxidase staining of formalin-fixed, paraffin-embedded tumour tissue sections is much less than the frequency of blood or urinary CEA elevations in patients with urothelial cancer.

Carcinoembryonic Antigen↗
PubMed1990

Computerized morphonuclear cell image analyses of malignant disease in bladder tissues.

We analyzed the relationship between several morphonuclear parameters related to nuclear size, densitometry (deoxyribonucleic acid content and ploidy) and the chromatin pattern versus the histopathological grading of 46 bladder cancer samples graded according to the World Health Organization classification. We used a SAMBA 200 cell image processor with software allowing for the discrimination of 15 different parameters on Feulgen-stained imprint smears. In addition, we set up preliminary data banks that enable objective and reproducible grading of unknown cases. This approach must be validated in a large series of cases to create an expert system for bladder malignancy diagnosis.

Cell Division↗
PubMed1988

Urge incontinence can be a disease of bladder sensors.

In many cases of urge incontinence the pathophysiology is unclear. Detrusor instability, detrusor hyperreflexia, urethral instability and poor sensory perception all have been suggested as requirements for urge incontinence. Sensory perception, as proposed recently, may be mediated by 2 bladder sensors. The first sensor, located at the trigone and posterior urethra, is sensitive to small changes in pressure and may function as an early warning system of bladder filling. In the diagnostic evaluation of urge incontinence 5 patients had a triad of absence of the first sensor, an intact second sensor, that is the urge to void when the bladder is stretched with fluid, and normal spontaneous detrusor contraction. Based upon these findings it is suggested that some instances of urge incontinence result when the early warning system fails and detrusor contraction occurs just shortly after the second sensor is stimulated. Detrusor instability was identified in 3 of the 5 patients with urge incontinence, and when present it was associated with urinary frequency. Thus, 2 forms of urge incontinence may be associated with loss of the first sensor: 1 with and the other without associated frequency, with the difference being the presence or absence of detrusor instability.

Aged↗
PubMed1998

A hypothesis for the etiology of interstitial cystitis based upon inhibition of bladder epithelial repair.

Interstitial cystitis (IC) is a chronic bladder disease characterized by distinct bladder mucosal abnormalities, for which the etiology is unknown. Although the epidemiology of this disorder is similar to that of bacterial cystitis, prospective studies using sensitive culture techniques and polymerase chain reaction assay for a variety of microorganisms have failed to identify a specific infectious etiology for IC. We have identified a low-molecular-weight peptide in the urine of IC patients that inhibits the proliferation of normal bladder epithelial cells in vitro. We therefore propose a model of IC, in which this peptide inhibits bladder epithelial regeneration following damage (such as that caused by bacterial cystitis). The chronically damaged epithelium is prone to colonization with various microorganisms, and the resulting exposure to these microorganisms, other urinary antigens, and/or damaged epithelial cells prompts the low-level inflammatory response commonly seen in this disorder.

Cystitis, Interstitial↗
PubMed1998

What is a healthy weight for middle aged women?

OBJECTIVE: To explore associations between body mass index (BMI) and selected indicators of health and well-being and to suggest a healthy weight range (based on BMI) for middle aged Australian women. DESIGN: Population based longitudinal study (cross-sectional baseline data). SUBJECTS: 13431 women aged 45-49 y who participated in the baseline survey for the Australian Longitudinal Study on Women's Health. RESULTS: Forty-eight percent of women had a BMI>25 kg/m2. Prevalence of medical problems (for example, hypertension, diabetes), surgical procedures (cholescystectomy, hysterectomy) and symptoms (for example, back pain) increased monotonically with BMI, while indicators of health care use (for example, visits to doctors) showed a 'J' shaped relationship with BMI. Scores for several sub-scales of the MOS short form health survey (SF36) (for example, general health, role limitations due to emotional difficulties, social function, mental health and vitality) were optimal when BMI was around 19-24 kg/m2. After adjustment for area of residence, education, smoking, exercise and menopausal status, low BMI was associated with fewer physical health problems than mid-level or higher BMI, and the nationally recommended BMI range of 20-25 was associated with optimum mental health, lower prevalence of tiredness and lowest use of health services. CONCLUSIONS: Acknowledging the limitations of the cross-sectional nature of these data, the results firmly support the benefits of leanness in terms of reducing the risk of cardiovascular disease, diabetes and gall bladder disease. The findings are moderated, however, by the observation that both low and high BMI are associated with decreased vitality and poorer mental health. The optimal range for BMI appears to be about 19-24 kg/m2. From a public health perspective this study provides strong support for the recommended BMI range of 20-25 as an appropriate target for the promotion of healthy weight in middle aged Australian women.

Australia↗
PubMed1981

The management of vesicoureteral reflux in children with neurogenic bladders.

Sixty-two children with 90 refluxing ureters and neurogenic bladder dysfunction were initially managed by clean intermittent catheterisation. The upper urinary systems demonstrated hydronephrosis and/or parenchymal scarring in 57 kidneys and were normal in 33. Each child was placed on low dose antimicrobials and followed nonoperatively unless there was evidence of a febrile urinary tract infection or upper tract deterioration at which point antireflux surgery or urinary diversion was performed. Our experience suggests that children with neurogenic bladders and reflux may be safely managed by clean intermittent catheterisation and that low or moderate degrees of reflux may actually disappear. If recurrent bacilliuria or febrile urinary infections are noted then ureteroneocystostomy is a reliable and effective treatment option in neurogenic bladder disease provided that the bladder dysfunction is controlled. Higher grades of reflux have proven more difficult to manage and in our experience the reflux has not spontaneously abated and frequently there are associated episodes of acute pyelonephritis and renal damage. Because of our success with reimplantation surgery, we now favour early ureteroneocystostomy in such circumstances. With effective management of the neurogenic bladder dysfunction with intermittent catheterisation permanent urinary diversion should only occasionally be necessary because of vesicoureteral reflux.

Adolescent↗
PubMed1998

Comparative analysis of p53 mutations in bladder washings and histologic specimens.

Mutations in the tumor suppressor gene p53, analyzed in bladder washings, have positive predictive value for the progression of superficial bladder cancer to invasive disease. Bladder washings reflect the general status of the urothelium, and because sampling of bladder washings can be performed as an outpatient procedure, patients can be monitored more carefully. To determine the actual value of bladder washing specimens in assessing the p53 status of histologic specimens, we used the technique of polymerase chain reaction-single-strand conformation polymorphism to analyze bladder washings and the synchronous tumors of 15 patients for the presence of p53 mutations. A significant correlation (2-tailed Fisher's exact test) between the p53 status of bladder washings and histologic specimens was observed if the 2 were compared among the specimens of a single patient. Overall, in 2 patients the mutation present in the tumors was not detected in the bladder washings, and in 1 patient the mutation in the bladder washing was not detected in the histologic specimens. These conflicting results obtained with bladder washings and histologic specimens could be explained mainly by the architecture of the tumors. The observed specificity of 86% and sensitivity of 75% emphasizes that although the correlation between the 2 methods is good, in a number of cases they are complementary to each other. The analysis of p53 mutations in at least 2 bladder washings gives insight into the p53 status of the synchronous tumors.

Genes, p53↗
PubMed1999

Uses and misuses of the new pharmacotherapy of obesity.

The worldwide epidemic of obesity has made the development of effective treatment ever more urgent. Appropriate use of medication for the treatment of obesity may benefit patients at risk for developing diabetes, hypertension, coronary artery disease, osteoarthritis or gall bladder disease. In addition, with the appearance of very safe medications, short-term treatment for the relief of the stigma associated with obesity may also be valuable. The currently available medications for obesity work either by reducing fat digestion or by acting on receptor systems in the brain. Both have potential side-effects, but may be useful alone or in combination. The expansion of knowledge about the control of obesity offers the hope that many new agents will become available over the next decade.

Appetite Depressants↗
PubMed1999

Subsequential telomerase activity in exfoliated urinary cells detects recurrent disease in bladder cancer after transurethral resection.

We assessed urinary telomerase activity in bladder cancer patients to provide additional information for monitoring after transurethral resection (TUR). Urinary telomerase activity was detected in 22/26 (84.6%) patients with known bladder tumor before TUR. Ten of 11 patients who were available for sequential follow-up examination had urinary telomerase activity before TUR. In 4 of the 10 patients, urinary telomerase activity disappeared following TUR with or without adjuvant intravesical therapy. Three of the remaining 6 patients had recurrent bladder tumors within three months after TUR. Urinary telomerase activity analysis from patients after TUR provides important information on microscopic recurrent bladder cancer.

Aged↗
PubMed1983

Antigen Dd reactivity in selected diseases.

The distribution of detectable antibodies against antigen Dd has been studied in rheumatoid arthritis, goitre, nephrotic syndrome, cirrhosis, gastrointestinal tract diseases, neurological diseases, liver and gall bladder diseases, breast cancer, respiratory diseases and cardiovascular diseases. Except in rheumatoid arthritis, breast cancer and nephrotic syndrome, where the incidence of antigen Dd-reactivity did not differ much from that in the control group, in all other disease it was significantly lower.

Adult↗
PubMed1979

Neurogenic bladder dysfunction.

The combined use of cystometry and perineal electromyography permits the physician to detect abnormalities in the synchronization of bladder contraction and urinary sphincter relaxation. With each pattern of neurogenic bladder disease, the coordination between bladder and sphincter determines whether urinary tract problems will develop. Treatment is tailored to specific bladder and sphincter defects.

Humans↗