No abstract

OBJECTIVE-Ménétrier's disease (MD) is a rare hypertrophic gastropathy characterised by giant rugal folds, hypochlorhydria, protein loss and a classic constellation of symptoms -nausea, vomiting, abdominal pain and peripheral oedema. It is considered a clinical diagnosis that, at times, may be difficult to establish. We propose firm diagnostic criteria for MD by delineating the clinicopathological features that best differentiate MD from its mimics. DESIGN-Forty-eight patients referred to Vanderbilt University Medical Center for consideration of enrolment in a clinical trial to treat MD patients with cetuximab were evaluated for a definitive diagnosis by assessment of clinical presentation, pertinent laboratory values and histopathological features.RESULTS-MD was confirmed in 25/48 (52%) of the patients. We designated the remaining 23 patients as mimics of MD; the most common diagnoses among the MD mimics were gastric polyps or polyposis syndromes (13/23, 57%). Gastric slides were available from 40 of 48 cases for detailed histological analysis (22/25 MD cases and 18/23 non-MD cases). Foveolar hyperplasia, glandular tortuosity and dilatation, and a marked reduction in parietal cell number were present in all 22 MD cases; lamina propria smooth muscle hyperplasia and oedema characterised most cases (18/22 and 19/22, respectively); more than half had prominent eosinophils (11/22) and/or plasma cells (12/22) in the lamina propria. The clinical presentation of MD patients was characterised by significantly younger age at onset, male predominance and increased vomiting compared to non-MD, and lower prevalence of anaemia compared to non-MD with polyps; there was trend towards increased frequency of peripheral oedema in MD versus non-MD.CONCLUSIONS-MD is most accurately diagnosed by clinicohistopathological analysis including esophagogastroduodenoscopy with gastric pH, appropriate laboratory tests (complete blood count, serum albumin, serum gastrin, H. pylori and cytomegalovirus serology) and full thickness mucosal biopsy of the involved gastric mucosa.Corresponding Author: Robert Coffey, robert.coffey@vanderbilt.edu, Tel: 615-343-6228, Fax: 615-343-1591 however, each has yielded inconsistent benefits, and none have been evaluated in a clinical trial. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The only definitive treatment is total gastrectomy. A recently published clinical trial from our group reported that MD patients treated with cetuximab, a monoclonal antibody to the epidermal growth factor receptor (EGFR), showed significant clinical and biochemical improvement in all 7 patients that completed the one-month trial with subsequent histological reversion to normal or near normal in 4 of these patients. [27][28][29] The pathogenesis of MD is related to increased EGFR signalling in the stomach. In vitro, administration of transforming growth factor-α (TGF-α), one of seven mammalian EGFR ligands, stimulates gastric epithelial growth, inhibits acid production and increases mucin levels...

OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $−9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 (anzctr.org.au)

During pulsation, central retinal vein collapse occurs in time with IOP and ICP diastole. Venous collapse is not induced by intraocular systole. These results suggest that ICP pulse pressure dominates the timing of venous pulsation.