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Abstract Background Consumers’ conviction of the benefits of probiotics is influenced by their existing beliefs and by the information they receive from healthcare professionals. The attitude of healthcare professionals towards commercially available probiotics will, therefore, determine how trustworthy and beneficial these products are perceived by consumers. Furthermore, due to European Union legislation, companies are prohibited from displaying information on product packaging; therefore, consumers are dependent primarily on healthcare professionals for correct information and guidance on the use of these products. The aim of this pilot study was to explore the understanding and use of probiotics in clinical practice by professionals who are involved in child healthcare in different European countries and to assess how much they value the scientific evidence behind these products. Methods The study was performed using a cross-sectional, descriptive, 30-question online questionnaire circulated among healthcare professionals belonging to three professional categories that are typically involved in childhood probiotic prescription: paediatricians, dieticians and general practitioners. The questionnaire was developed using web-based standard guidelines, and the questions were modelled on those used in previously published probiotics studies. Results Overall, 27,287 healthcare professionals belonging to three major European scientific societies were contacted by the organizations participating in the study. In total, 1360 valid questionnaires were recorded, and the results were statistically analysed. Conclusions The results emphasize the importance for healthcare professionals to be properly educated and updated on probiotics. An improved knowledge about probiotics led to increased prescriptive confidence. To disseminate accurate information on probiotics, healthcare professionals look for appropriate and scientifically validated educational platforms to acquire information, explore concerns and barriers and look for positive approaches towards recommending probiotics.

The Adriatic Sea is an important foraging area for the loggerhead sea turtle, Caretta caretta, but neritic habitats for this species along the Italian coast were identified in the northern shallow area only. The Gulf of Manfredonia is a relatively wide shallow area in the south-west Adriatic and its features and preliminary information make it a potential foraging ground for turtles. In order to assess sea turtle occurrence in the area, we monitored seven bottom trawlers based in the port of Manfredonia during the period Oct 2010 – Jul 2011 through a voluntary logbook programme, resulting in a total of 62 turtle captures during 617 fishing days. Since a turtle capture represents a rare event during such sampling, data were analysed by a zero-inflated Poisson (ZIP) model. Results indicate that: (i) the Gulf is a neritic foraging ground for loggerhead turtles which occur there with a relatively high density comparable to other Mediterranean foraging grounds, (ii) it is frequented by a wide range of size classes, including small juveniles as well as adults, (iii) the highest occurrence is during the period Jun-Dec, (iv) over 1700 turtle captures occur in the Gulf annually. Preliminary findings about recaptured individuals suggest that part of the turtles are resident in the area. The peculiar features of the Gulf of Manfredonia and the collaboration of the fishing fleet, make it a valuable index site for studying current trends of sea turtle populations at sea as well as other aspects of sea turtle biology and conservation.

Gastric emptying of two different test liquid meals (500 ml isotonic saline and 500 ml skimmed milk, 1.8% fat) has been measured in 10 (saline) and in 19 (milk) normal volunteers by means of real-time ultrasonography (RUS) and scintigraphy, employed simultaneously. In each subject, saline and milk contained 37 MBq of diethylenetriaminopentacetic acid (DPTA) marked with 99mTc. Determinations were made thereafter every 5 min up to 45 min with saline and every 30 min up to a maximum of 220 min with milk. The determination of gastric emptying by RUS was obtained indirectly through the measurement of gastric dimensions, with a single scan performed at the epigastrium, while the subject was kept in a standing position. At each observation, the percent decrease of gastric measurements and the decay in radioactivity over the gastric region were calculated, blind, by two independent examiners. Linear regression and correlation coefficient were subsequently computed for gastric measurements and decay in radioactivity. The results show that the values obtained with RUS do not differ grossly from the ones obtained with scintigraphy. This suggests that the ultrasonographic determination of gastric dimensions with a single section of the stomach may be a valuable method for use in the evaluation of gastric emptying of liquids. [ABSTRACT FROM AUTHOR]

Methods: The efficacy of pancreatic stenting in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) was evaluated by a meta-analysis of 6 controlled studies; 12 additional uncontrolled studies were analyzed for rates of associated risk., Results: Post-ERCP pancreatitis (PEP) developed in 16.5% of controls, and in 5.1 or 9.6% of the stent group at the per-protocol (PP) or intention-to-treat (ITT) analyses. By analyzing only the 4 randomized trials, PEP developed in 24.1% of controls, and in 6.1 or 12.0% of the stented patients at the PP or ITT analyses. Risk was significantly lower in the stent group when compared with controls: OR 0.44 (95% CI 0.24-0.81). The absolute risk reduction is 12.0 (95% CI 3.0-21.0), the number needed to treat 8 (95% CI 5-34), and the publication bias 2. ORs for mild to moderate PEP were reduced in the stent group (OR = 0.537, 95% CI 0.283-1.021), as were those for severe PEP (OR = 0.123, 95% CI 0.021-0.726). Non-pancreatic complications were 4.2%, and included early stent migration (1.4%), perforations (0.4%), bleeding (1.4%), and infections (1.0%)., Conclusion: Available trials show benefit for pancreatic stenting in the prophylaxis of PEP, but more randomized studies are needed before endorsing a routine use of this endoscopic procedure., (2007 S. Karger AG, Basel)

ABO-incompatible (ABO-I) liver transplantation is a controversial issue because of the generally less favorable outcome as compared to compatible transplants. Encouraging results have been shown by the introduction of new strategies to reduce posttransplant-specific hemagglutinin (HA) titers with plasmapheresis, reinforced immunosuppression (IS), and the use of splenectomy. We describe a new protocol consisting of daclizumab (DAC) induction, mycophenolate mofetil (MMF)/tacrolimus (TAC)/steroids without splenectomy. Five recipients (mean age of 47 +/- 14 yr) undergoing ABO-I living donor liver transplantation (LDLT) were included in this protocol. Immunoadsorbent columns (Glycosorb ABO) were used for antigen-specific immunoadsorption (ASI). The median follow-up was 18.5 +/- 10.5 months. ASI was very efficient in lowering HA titers (mean log(2) immunoglobulin [Ig] M [IgM] and IgG values before and after ASI were 5.9 +/- 2.8 and 1.2 +/- 1.4 [P= 0.0038] and 6.5 +/- 2.3 and 1.1+/- 1.9, respectively [P= 0.0001]). Persisting low HA titers were observed over time. No sepsis nor cytomegalovirus infection episodes were recorded. Acute cellular rejection (ACR) occurred in 1 recipient responding to steroid pulse therapy. Two grafts were lost in 2 patients due to technical failure during the first postoperative month. We conclude that ASI using Glycosorb ABO, quadruple immunosuppression including DAC and MMF provide high efficiency to lower HA titers over time, avoiding the need for splenectomy. ABO-I LDLT can be performed with this adapted IS protocol.

Aims: This study was carried out to evaluate whether the 13C-urea breath test could assess the intragastric Helicobacter pylori load and predict the outcome of infected subjects undergoing short-term triple therapy., Methods: A total of 108 infected patients underwent upper endoscopy with antral biopsies and histological grading of Helicobacter pylori density. These patients received omeprazole 20 mg b.i.d., clarithromycin 500 mg b.i.d., and amoxycillin 1000 mg b.i.d. or tinidazole 500 mg b.i.d. for one week. 13C-urea breath test (75 mg 13C-urea; results expressed as Delta Over Baseline values at 30') was performed before and after therapy. According to pre-treatment Delta Over Baseline at 30' values, patients were assigned to low (< 16/1000), intermediate (16-35/1000) and high (> 35/1000) Delta Over Baseline at 30' groups., Results: A significant correlation was found between pre-treatment Delta Over Baseline at 30' values and the density of Helicobacter pylori (rs = 0.76). The eradication rates were 82%, 67%, and 17% in the low, intermediate, and high Delta Over Baseline at 30' groups, respectively (p = 0.0001). When classified according to the outcome of therapy, the median pre-treatment Delta Over Baseline at 30' value was 15.7 in eradicated subjects vs 21.6 in non eradicated patients (p = 0.002). In patients who failed eradication, a significant difference was also observed between pre- and post-treatment Delta Over Baseline at 30' values (21.6 vs 15.6, p = 0.019)., Conclusions: The 13C-urea breath test can be used to evaluate the intragastric bacterial load and to predict the outcome of standard eradication treatment.

Patients with chest pain and/or dysphagia may present non-specific motor abnormalities that do not fit into classical categories of primary motor disorders. Two such patients are described, both with segmental aperistalsis of the distal oesophagus and with fairly normal proximal motility and LES function. Delayed radionuclide oesophageal transit was noted in both cases. Medical treatment was only partially effective and one patient required pneumatic dilatation. The aperistaltic segments have remained unchanged over 3-4 year follow-ups. These patients account for less than 1% of all those diagnosed with oesophageal motor abnormalities in our hospital in the last ten years.

The frequency of peptic ulcer and the role of ulcerogenic risk factors in cirrhotic patients were evaluated in a retrospective study. Peptic disease was observed in 18.2% of the cirrhotic patients examined. When compared to the prevalence of ulcerative lesions in the general population, this finding suggests that cirrhotic patients have the same probability of being affected by peptic ulcer as non-cirrhotic subjects. The analysis of ulcerogenic risk factors highlighted the importance of alcohol and smoking. The etiology of cirrhosis and portal hypertension were not found to be important. In conclusion, peptic disease is not more frequent in cirrhotic patients than in the general population.

Granular cell tumor (GCT) of the esophagus is a rarely-met-with neoplasm. It is almost invariably benign in character and is of still-disputed histogenesis. Small lesions are asymptomatic. Those over 1 cm in diameter may be accompanied by painful swallowing or retrosternal discomfort. Local resection is the treatment of choice for lesions that are accompanied by symptoms, or that are larger than 1 cm. A tumor incidentally encountered in an asymptomatic patient may be safely followed endoscopically. A successful endoscopic removal of such a lesion is described.