Current Perspectives in Atrophic Gastritis Lahner, Edith; Conti, Laura; Annibale, Bruno ...
Current gastroenterology reports,
08/2020, Letnik:
22, Številka:
8
Journal Article
Recenzirano
Purpose of the Review
Atrophic gastritis is a complex syndrome with gastric atrophy as a common trait.
Helicobacter pylori
infection and autoimmunity are the two main contexts in which it develops. ...It is slightly symptomatic, affects various aspects of general health, and remains a predisposing factor for gastric cancer. This review will update current knowledge and progress on atrophic gastritis.
Recent Findings
Atrophic gastritis affects mostly adults with persistent dyspepsia, deficient anemia, autoimmunity disease, long-term proton pump inhibitor use, and a family history of gastric cancer. Gastric biopsies, expressed as Sydney system grade and OLGA/OLGIM classifications, represent the gold standard for diagnosis and cancer risk stage, respectively. Recently, electronic chromoendoscopy has allowed “targeted biopsies” of intestinal metaplasia. The associated hypochlorhydria affects the gastric microbiota composition suggesting that non-
Helicobacter pylori
microbiota may participate in the development of gastric cancer.
Summary
Physicians should be aware of multifaceted clinical presentation of atrophic gastritis. It should be endoscopically monitored by targeted gastric biopsies. Autoimmune and
Helicobacter pylori
-induced atrophic gastritis are associated with different gastric microbial profiles playing different roles in gastric tumorigenesis.
Hybrid coronary revascularization (HCR) combines the benefits of a left internal mammary artery to left anterior descending artery anastomosis, via a mini thoracotomy, with percutaneous coronary ...intervention (PCI) for other diseased coronaries.
The aim of this meta-analysis is to compare the short- and long-term outcomes of HCR with those of coronary artery bypass grafting (CABG) for multi-vessel coronary artery disease (MCAD).
We performed a meta-analysis with a primary outcome of short-term mortality and secondary outcomes of mid-term survival, length of hospital stay, stroke, renal failure and mid-term MACE rate.
3399 patients (HCR = 1164, CABG = 2235) were included, with no significant difference in short-term mortality between groups (OR = 1.50, 95% CI = 0.90,2.49, p = 0.11), although a higher mortality rate was seen in the HCR group (0.73% vs 0.64%). The average length of stay in intensive care unit was significantly shorter following HCR than CABG (mean difference = −15.52 h, CI = −22.47,-8.59, p˂0.001) and overall hospital stay was also shorter in this group, although not statistically significant (mean difference = −3.15 days, 95% CI = −6.55, 0.25, p = 0.07). HCR was associated with a reduced odds of blood transfusion (OR = 0.34, 95% CI = 0.22,0.54, p < 0.001). There was not a significant difference in mid-term survival (OR = 0.86, 95% CI = 0.62,1.21, p = 0.39) or MACE rate (OR = 0.82, 95% CI = 0.55,1.23, p = 0.34). No differences were found between HCR and CABG for post-operative stroke (OR = 1.36, 95% CI = 0.87, 2.13, p = 0.16) or renal failure (OR = 0.71, 95% CI = 0.43,1.16, p = 0.14).
HCR has a higher incidence of short-term mortality compared to CABG in patients with MCAD, although this difference is not statistically significant. Similar rates of mid-term survival and other short term post-operative complications were found between the two groups. HCR has a shorter ICU stays and reduced requirement for blood transfusion.
•The aim of this meta-analysis is to compare the short- and mid-term outcomes of Hybrid coronary revascularisation (HCR) with those of coronary artery bypass grafting (CABG) for multi-vessel coronary artery disease (MCAD).•HCR can be performed in patients with MCAD with similar rates of mid-term survival and post-operative complications compared to standard CABG, but with a trend in higher short term mortality.•HCR has an enhanced recovery with shorter ICU stays, reduced requirement for blood transfusion and shorter hospital stays.
Background and Aim of the Study
To report early clinical outcomes of the frozen elephant trunk (FET) technique for the treatment of complex aortic diseases after transition from conventional elephant ...trunk.
Methods
A single‐center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement.
Results
Between December 2017 and May 2020, 70 consecutive patients (62.7 ± 10.6 years, 59 male) were treated: 41 (58.6%) for emergent conditions and 29 (41.4%) for elective. Technical success was 100%. In‐hospital mortality was 14.2% (n = 12, 17.1% emergent vs. 10.3% elective, P = NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Mean follow‐up was 12.5 months (interquartile range, 3.7–22.3). Overall survival at 3, 6, 12, and 24 months was 90% (95% confidence interval CI, 83.2—97.3), 85.6% (95% CI, 77.7–94.3), 79.1% (95% CI, 69.9–89.5), 75.6% (95% CI, 65.8–86.9) and 73.5% (95% CI, 63.3–85.3). There were no aortic re‐interventions and no distal stent graft‐induced new entry (dSINE); 5 patients with residual type B dissection underwent TEVAR completion.
Conclusions
In a real‐world setting, FET with Thoraflex Hybrid demonstrated feasibility and good clinical outcomes, even in emergent setting. Our implant technique optimize cerebral perfusion reporting good results in terms of neurological complications. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.
The choice of ring for mitral valve repair is still largely left to the surgeon's preferences and there are no specific guidelines regulating this decision. Despite this previous researches have ...described important features appertaining to each of the different types of rings currently available. Particularly, the debate is still open in regards to the flexibility that these devices should or should not have. Later in this issue of the Journal, Panicker and colleagues have reported their results with flexible and rigid rings in mitral valve repair. The results are very interesting and once again are highlighting the importance of using the right ring for the right disease.
Abstract
OBJECTIVES
Our goal was to describe the experience at 2 centres with off-pump coronary artery bypass grafting using a left thoracotomy.
METHODS
From January 2002 to December 2017, a total of ...2528 consecutive patients (578 women, mean age 62.3 ± 9.1 years) were operated on using this technique. Data were collected prospectively and analysed retrospectively.
RESULTS
There were no conversions to median sternotomy and 6 patients (0.2%) were converted to on-pump CABG. The mean number of grafts per patient was 2.8 ± 0. 9. The 30-day mortality rate was 1.0% (25 patients). Most patients were extubated in the operating theatre (97.3%), and 47 patients (1.9%) needed re-exploration for bleeding. Seven patients (0.3%) experienced a cerebrovascular event; 4 (0.3%) had a postoperative myocardial infarction; and 84 (3.4%) had new-onset atrial fibrillation. A total of 1510 patients (61.1%) were discharged from the hospital in the first 48 h after surgery. Long-term survival rates were 98.8%, 93.6% and 69.1% at 1, 5 and 10 years, respectively (central image). During the follow-up period, 60 patients (2.9%) were re-examined for recurrence of angina with a new coronary angiogram; of those, 24 (1.2%) required percutaneous coronary intervention and 11 (0.5%) had redo surgery.
CONCLUSIONS
A left thoracotomy is a safe alternative to a median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid- and long-term results.
Background: Myocardial infarction (MI) is a major cause of death and disability worldwide with 20% and 45% mortality at 1- and at 5-year respectively. Following MI several detrimental changes are ...known to occur in the myocardium and a better understanding of these changes would be beneficial for the prevention and treatment of the disease. The aim of this research project was to develop and characterise a large animal model of closed-chest balloon MI with ischaemia reperfusion injury for diagnostic and therapeutic purposes. Methods: From November 2016 to March 2018, a closed-chest MI model using percutaneous coronary occlusion was performed in 65 Yorkshire swine. This thesis reports the clinical, haemodynamic, and biochemical parameters related to the model. In addition, this thesis reports the findings cardiac magnetic resonance (CMR) studies performed in the acute and chronic phase after MI. Results: In total, 65 experiments were performed. Overall experiment-related mortality was 6.1% with 40% of the animals demonstrating malignant arrhythmia during the induction of MI. Longer periods of coronary occlusion (90 minutes vs 60 minutes) resulted in a higher incidence of complications and mortality rate. The average scar size by CMR in the acute phase was 20.70±7.24 grams (as percentage of LV mass = 21.61±7.58 %) at early CMR, and at chronic time point was 8.38±3.5 grams (as percentage of LV mass = 7.93±3.36 %). The left ventricular function (LVEF) decreased significantly at early CMR with a mean value of 43.21±8.62 %. The mean value of cardiac troponin I four hours after MI was 87.47 ± 48.62 ng/ml. Conclusion: With this work we have been able to develop a reliable and highly reproducible model of acute MI in large animal. The model is affected by a very low failure rate, produces a consistent myocardial scar, and can be used for multiple therapeutic and diagnostic purposes in MI.
PDF
