Publications (56) View all
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Article: Functional chest pain responds to biofeedback treatment but functional heartburn does not: what is the difference?
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ABSTRACT: Patients with functional esophageal disorders represent a challenging treatment group. The purpose of this study was to evaluate the role of biofeedback in the treatment of patients with functional esophageal disorders. In this prospective study, patients with typical/atypical symptoms of gastroesophageal reflux disease underwent upper endoscopy and 24-h pH monitoring. All patients filled out gastroesophageal Reflux Disease Symptom, Hospital Anxiety and Depression, and Symptom Stress Rating questionnaires. Patients with functional heartburn and those with functional chest pain were offered biofeedback treatment. A global assessment questionnaire was filled out at the end of treatment and then 2.8 (range 1-4) years later. From January 2006 to December 2009, 22 patients with functional esophageal diseases were included in the study. Thirteen had functional heartburn and nine had functional chest pain. Six patients from each group received biofeedback treatment. After treatment for 1-4 years, patients with functional chest pain showed significant improvements in symptoms compared with those who were not treated. Patients with functional heartburn showed no improvement. Patients with functional chest pain had a longer time of esophageal acid exposure than those with functional heartburn. Patients with functional chest pain have different central and intraesophageal factors associated with symptom generation in comparison with patients with functional heartburn. Biofeedback is a useful tool in the treatment of patients with functional chest pain, but not for those with functional heartburn.European journal of gastroenterology & hepatology 03/2012; 24(6):708-14. · 1.66 Impact Factor -
Article: Effect of personalization and candy incentive on response rates for a mailed survey of dermatologists.
Journal of Investigative Dermatology 12/2011; 132(3 Pt 1):724-6. · 6.31 Impact Factor -
Article: Medical radiation exposure and risk of retinoblastoma resulting from new germline RB1 mutation.
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ABSTRACT: Although ionizing radiation induces germline mutations in animals, human studies of radiation-exposed populations have not detected an effect. We conducted a case-control study of sporadic bilateral retinoblastoma, which results from a new germline RB1 mutation, to investigate gonadal radiation exposure of parents from medical sources before their child's conception. Parents of 206 cases from nine North American institutions and 269 controls participated; fathers of 184 cases and 223 friend and relative controls and mothers of 204 cases and 260 controls provided information in telephone interviews on their medical radiation exposure. Cases provided DNA for RB1 mutation testing. Of common procedures, lower gastrointestinal (GI) series conferred the highest estimated dose to testes and ovaries. Paternal history of lower GI series was associated with increased risk of retinoblastoma in the child [matched odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.2-11.2, two-sided p = 0.02], as was estimated total testicular dose from all procedures combined (OR for highest dose=3.9, 95% CI = 1.2-14.4, p = 0.02). Maternal history of lower GI series was also associated with increased risk (OR = 7.6, 95% CI = 2.8-20.7, p < 0.001) as was the estimated total dose (OR for highest dose = 3.0, 95% CI = 1.4-7.0, p = 0.005). The RB1 mutation spectrum in cases of exposed parents did not differ from that of other cases. Some animal and human data support our findings of an association of gonadal radiation exposure in men and women with new germline RB1 mutation detectable in their children, although bias, confounding, and/or chance may also explain the results.International Journal of Cancer 05/2011; 128(10):2393-404. · 5.44 Impact Factor -
Article: Intima-media thickness of the common carotid artery is not significantly higher in Crohn's disease patients compared to healthy population.
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ABSTRACT: Patients with Crohn's disease might have accelerated atherosclerosis due to: chronic systemic inflammation, metabolic changes or prolonged steroid treatment. The aim of this study was to assess the risk of sub-clinical atherosclerosis in Crohn's disease, by measuring the intima-media thickness and peak systolic velocity of the common carotid artery. Fifty Crohn's disease patients aged between 20 and 45 years were compared to 25 controls. Patients with a family history of cardiovascular diseases or a known risk for atherosclerosis were excluded. All participants underwent nutritional assessment. Carotid artery ultrasonography was performed and intima-media thickness and peak systolic velocity were measured, proximal to the common carotid bifurcation. Clinical data and laboratory parameters (hemoglobin, highly sensitive C-reactive protein, and plasma homocysteine) were determined. No significant differences between the groups were found for intima-media thickness or peak systolic velocity. Multiple regression analysis revealed a positive correlation of intima-media thickness with older age. Peak systolic velocity was negatively associated with age. Crohn's disease patients do not have an increased risk for developing early atherosclerosis.Digestive Diseases and Sciences 01/2011; 56(1):197-202. · 2.12 Impact Factor -
Article: Inflammation and the host response to injury, a large-scale collaborative project: patient-oriented research core--standard operating procedures for clinical care VII--Guidelines for antibiotic administration in severely injured patients.
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ABSTRACT: When the clinical decision to treat a critically ill patient with antibiotics has been made, one must attempt to identify the site of infection based on clinical signs and symptoms, laboratory or diagnostic radiology studies. Identification of site requires, examination of patient, inspection of all wounds, chest radiograph, and calculation of clinical pulmonary infection score if ventilated, obtaining blood cultures, urinalysis, and line change if clinical suspicion of central venous catheter (CVC) source. If it is impossible to identify site, obtain cultures from all accessible suspected sites and initiate empiric, broad spectrum antibiotics. If likely site can be identified answer these questions: Is intra-abdominal site suspected? Is pulmonary source of infection suspected? Is skin, skin structure or soft tissue site suspected? If yes, does the patient have clinical signs suspicion for necrotizing soft tissue infection (NSTI)? Is a CVC infection suspected? Risk factors for more complicated infections are discussed and specific antibiotic recommendations are provided for each type and severity of clinical infection. Decision to continue, discontinue and/or alter antibiotic/antimicrobial treatment should be based on the clinical response to treatment, diagnostic or interventional findings, and culture and sensitivity data, bearing in mind that not all patients with infections will have positive cultures because of limitations of specimen handling, microbiology laboratory variations, time between specimen acquisition and culture, or presence of effective antibiotics at the time that specimens were obtained. It should also be noted that not all patients with increased temperature/WBC have an infection. Discontinuation of antibiotics is appropriate if cultures and other diagnostic studies are negative.The Journal of trauma 01/2009; 65(6):1511-9. · 2.48 Impact Factor
