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Background Eosinophilic oesophagitis is a chronic inflammatory disorder of the oesophagus, characterised by the proton pump inhibitor-refractory accumulation of eosinophils in the oesophageal epithelium (>15 intraepithelial eosinophils / high powered field). Adults present with solid food dysphagia and recurrent food impactions. Oesophageal remodelling produces the characteristic endoscopic feature of adult eosinophilic oesophagitis including strictures, rings and a narrow calibre oesophagus. Aim To evaluate the safety and efficacy of oesophageal dilation as the initial therapy for adults with eosinophilic oesophagitis. Methods Medline search from 1975 to November 2010 for all reports of the treatment of patients with eosinophilic oesophagitis using search words: eosinophilic oesophagitis treatment, dilation and eosinophilic oesophagitis, steroids and eosinophilic oesophagitis. Results Our systematic review found that 92% of patients treated with oesophageal dilation had improvement in their dysphagia symptoms for up to 1-2 years. Three case series clearly showed clinical resolution of dysphagia symptoms, independent of the degree of eosinophil infiltration, which was unchanged after dilation. Postprocedure pain for several days is common, due to some degree of mucosal tear, but true perforation very rare (<0.1%). Conclusions Oesophageal dilation is an acceptable option for healthy adult eosinophilic oesophagitis patients with anatomic narrowing, possibly followed by a course of topical steroids to reduce inflammation and retard remodelling. Future studies should include a head-to-head comparison of topical steroids and oesophageal dilation, bougie vs through-the-scope balloon dilation and maintenance topical steroids compared with on-demand treatment. [ABSTRACT FROM AUTHOR]

The goal of this article is to present the results of the long-term treatment with esophageal dilation of a consecutive series of adults with eosinophilic esophagitis (EoE). EoE in adults is a disease of middle aged white males, with recurrent food impactions and dysphagia. The exact treatment of EoE is unknown due to the uncertainty of the pathogenesis. Currently, the long-term follow-up of adult EoE patients is limited. Sixteen consecutive adult patients (12 males/4 females between ages 27 and 58 years) with EoE underwent a detailed history and baseline upper gastrointestinal endoscopy (EGD) with multiple esophageal biopsies. Thirteen had esophageal dilation. Fifteen were on proton pump inhibitor (PPI) therapy. After dilation, one patient was treated with a restrictive diet. One patient took prn fluticasone. Most of the patients had allergy testing for food and aeroallergens. Follow-up evaluation with similar testing was on average 22 months (range: 12–40 months). Six patients were not available for follow-up. None of the remaining 10 patients had a food impaction; one required further esophageal dilation. Only two patients had intermittent dysphagia. The average dysphagia score decreased from 2.1 to 0.3 ( P < 0.002). The average number of eosinophils at follow-up was not significantly different from baseline (120 eosinophils/HPF proximally and 165 eosinophils/HPF distally ( P= 0.75). The gross endoscopy findings were unchanged in all patients except one who normalized. A total of 62% and 75% of patients had positive tests for aeroallergens and food allergens, respectively. Over an average of two years, esophageal dilation provided excellent symptomatic relief among 10 adult EoE patients despite no improvement in the mucosal eosinophilia or gross endoscopic appearance. [ABSTRACT FROM AUTHOR]

Abstract: The presence of hydrosoluble species, mainly chlorides and sulphates, at the metal/paint interface promotes osmotic blistering of the coating and underfilm metallic corrosion when the concentration of the soluble salts exceeds a critical level. Both processes can lead to the deterioration of the paint system in a very short period of time. The International Standards Organization (ISO) has for some time been trying to develop a standard about guidance safe levels for water-soluble salt contamination before the application of paints and related products. However, it is difficult to set acceptable unique levels since each type of coating and thickness varies in susceptibility to soluble salt degradation and also the exposure conditions vary. In this study, by a variety of accelerated and natural weathering trials, realistic series of limits of soluble salt have been provided depending on the coating systems and exposure conditions. The results show that the generalised levels suggested in the draft version of the ISO standard are far too low compared with the critical levels obtained here. It is suggested that higher levels could be defined, which would save costs and time. [Copyright &y& Elsevier]

The article presents a study which examines the extrapyramidal symptoms of patients with tardive dyskinesia in Maryland. It aims to determine the relationship of tardive dyskinesia symptoms to the cessation of neuroleptic medication, increase in dosage levels and use of antiparkinson agents. A sample of chronic hospital in-patients at Spring Grove State Hospital in Maryland served as subjects of the study. The patients' medical-psychiatric records were reviewed and conventional neurological examinations and analysis of clinical laboratory records were conducted. Results indicate that symptom severity is lower during neuroleptic treatment. Antiparkinson drugs failed to reduce symptom manifestation and no relationship between symptom severity and dosage was found.