RESUMEN
AIM: To compare small bowel (SB) cleanliness and capsule endoscopy (CE) image quality following Ensure(®), polyethylene glycol (PEG) and standard preparations. METHODS: A preparation protocol for CE that is both efficacious and acceptable to patients remains elusive. Considering the physiological function of the SB as a site for the digestion and absorption of food and not as a stool reservoir, preparation consisting of a liquid, fiber-free formula ingested one day before a CE study might have an advantage over other kinds of preparations. We conducted a prospective, blind-to-preparation, two-center study that compared four types of preparations. The participants' demographic and clinical data were collected. Gastric and SB transit times were calculated. The presence of bile in the duodenum was scored by a single, blinded-to-preparation gastroenterologist expert in CE, as was cleanliness within the proximal, middle and distal part of the SB. A four-point scale was used (grade 1 = no bile or residue, grade 4 ≥ 90% of lumen full of bile or residual material). RESULTS: The 198 consecutive patients who were referred to CE studies due to routine medical reasons were divided into four groups. They all observed a 12-h overnight fast before undergoing CE. Throughout the 24 h preceding the fast, control group 1 (n = 45 patients) ate light unrestricted meals, control group 2 (n = 81) also ate light meals but free of fruits and vegetables, the PEG group (n = 50) ate unrestricted light meals and ingested the PEG preparation, and the Ensure group (n = 22) ingested only the Ensure formula. Preparation with Ensure improved the visualization of duodenal mucosa (a score of 1.76) by decreasing the bile content compared to preparation with PEG (a score of 2.9) (P = 0.053). Overall, as expected, there was less residue and stool in the proximal part of the SB than in the middle and distal parts in all groups. The total score of cleanliness throughout the length of the SB showed some benefit for Ensure (a score of 1.8) over control group 2 (a score of 2) (P = 0.06). The cleanliness grading of the proximal and distal parts of the SB was similar in all four groups (P = 0.6 for both). The cleanliness in the middle part of the SB in the PEG (a score of 1.8) and Ensure groups (a score of 1.7) was equally better than that of control group 2 (a score of 2.1) (P = 0.057 and P = 0.07, respectively). All 50 PEG patients had diarrhea as an anticipated side effect, compared with only one patient in the Ensure group. CONCLUSION: Preparation with Ensure, a liquid, fiber-free formula has advantages over standard and PEG preparations, with significantly fewer side effects than PEG.
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Endoscopía Capsular , Dieta , Sacarosa en la Dieta/administración & dosificación , Enfermedades Intestinales/diagnóstico , Mucosa Intestinal/patología , Intestino Delgado/patología , Polietilenglicoles/administración & dosificación , Irrigación Terapéutica/métodos , Administración Oral , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Sacarosa en la Dieta/efectos adversos , Ayuno , Femenino , Alimentos Formulados , Tránsito Gastrointestinal , Humanos , Enfermedades Intestinales/patología , Enfermedades Intestinales/fisiopatología , Intestino Delgado/fisiopatología , Israel , Masculino , Persona de Mediana Edad , Polietilenglicoles/efectos adversos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Irrigación Terapéutica/efectos adversosRESUMEN
AIM: To determine whether adding vitamin D, a potent immunomodulator, improves the hepatitis C virus (HCV) response to antiviral therapy. METHODS: Seventy-two consecutive patients with chronic HCV genotype 1 were randomized into two groups: the treatment group (n = 36, 50% male, mean age 47 ± 11 years) received Peg-α-2b interferon (1.5 µg/kg per week) plus ribavirin (1000-1200 mg/d) together with vitamin D3 (2000 IU/d, target serum level > 32 ng/mL), and the control group (n = 36, 60% male, mean age 49 ± 7 years) received identical therapy without vitamin D. HCV-RNA was assessed by real-time polymerase chain reaction (sensitivity, 10 IU/mL). The sustained virologic response (SVR) was defined as undetectable HCV-RNA at 24 wk post-treatment. RESULTS: Clinical characteristics were similar in both groups. The treatment group had a higher mean body mass index (27 ± 4 kg/m² vs 24 ± 3 kg/m²; P < 0.01), viral load (50% vs 42%, P < 0.01), and fibrosis score (> F2: 42% vs 19%, P < 0.001) than the controls. At week 4, 16 (44%) treated patients and 6 (17%) controls were HCV-RNA negative (P < 0.001). At week 12, 34 (94%) treated patients and 17 (48%) controls were HCV-RNA negative (P < 0.001). At 24 wk post-treatment (SVR), 31 (86%) treated patients and 15 (42%) controls were HCV-RNA negative (P < 0.001). Viral load, advanced fibrosis and vitamin D supplementation were strongly and independently associated with SVR (multivariate analysis). Adverse events were mild and typical of Peg-α-2b/ribavirin. CONCLUSION: Adding vitamin D to conventional Peg-α-2b/ribavirin therapy for treatment-naïve patients with chronic HCV genotype 1 infection significantly improves the viral response.
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Antivirales/uso terapéutico , Suplementos Dietéticos , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Adulto , Quimioterapia Combinada , Hepatitis C Crónica/sangre , Hepatitis C Crónica/virología , Humanos , Factores Inmunológicos/uso terapéutico , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Estudios Prospectivos , ARN Viral/sangre , Proteínas Recombinantes/uso terapéutico , Carga Viral , Vitamina D/administración & dosificación , Vitamina D/sangre , Vitaminas/administración & dosificación , Vitaminas/sangreRESUMEN
Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well established methodology for evaluating the entire small bowel for manifold pathologies. CE far exceeded early expectations by providing a tool for establishing the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohn's disease, polyposis syndrome and others. Contemporary CE, like radiology, gives results that can only be read, unlike conventional endoscopic procedures which enable concomitant biopsy when indicated. This is one of the major limitations of the technique. The ideal CE should improve the quality of the image and have a faster frame rate than the currently available one. There should be a therapeutic capsule capable of performing a biopsy, aspirating fluid, delivering drugs as well as measuring the motility of the small bowel wall. Another major leap forward would be the capability of remote control of the capsule's movement in order to navigate it to reach designated anatomical areas for carrying out a variety of therapeutic options. Technology for improving the capability of the future generation capsule is almost within grasp and it would not be surprising to witness the realization of these giant steps within the coming decade.
RESUMEN
Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.
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Píloro , Digestión , Endoscopía , Nutrición Enteral/efectos adversos , Nutrición Enteral/métodos , Humanos , Intubación Gastrointestinal/métodos , Yeyunostomía/efectos adversos , Yeyunostomía/métodos , Yeyuno , Apoyo NutricionalRESUMEN
BACKGROUND: Ulcerative colitis (UC) is a systemic disease of unknown etiology with extra-intestinal manifestation. Induced sputum (IS) non-invasively assesses extrapulmonary involvement in Crohn's disease. We sought to determine whether there is a cellular marker of lung injury in UC patients detectable by IS. METHODS: Nineteen UC patients (mean age 46.4+/-11.3 years, disease duration 8.6+/-7.5 years [range 1-25 years] 68.4% males) were studied, 6 with active disease and 13 in remission. Eleven received 5-ASA, 5 received steroids and/or azathioprine and 3 patients were untreated. UC patients were compared with 27 healthy non-smoker controls. IS was recovered after 20 min inhalation of 3% saline with an ultrasonic nebulizer by the selecting plugs method, and 300 cells were differentially cell counted in cytospin Giemsa-stained slides. CD4/CD8 subsets were identified by FACS. Pulmonary function tests were performed by the Jaeger Masterlab spirometer. RESULTS: UC patients' IS contained higher %eosinophils than controls (p=0.05) and lower FEV(1)/FVC ratios (p=0.001). Steroid- and/or azathioprine-treated patients had significantly lower FEV(1)/FVC ratios than only 5-ASA-treated patients (p=0.019). Eosinophil infiltration in airways was high in 5-ASA-treated patients compared to those receiving steroids and/or azathioprine (p=0.046) and those with less extensive disease (p=0.05). Using a cutoff of 3% eosinophils, IS had a sensitivity of 67% and specificity of 73% to differentiate patients with a cutoff of 70 eosinophils/mm(2) in biopsy. CONCLUSIONS: The percentage of sputum eosinophils is significantly different between UC patients with proctitis and pancolitis. These immune abnormalities may be a common pattern that is present throughout the mucosae.
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Colitis Ulcerosa/patología , Eosinófilos/citología , Intestinos/inmunología , Pulmón/patología , Esputo/citología , Subgrupos de Linfocitos T/citología , Estudios de Casos y Controles , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/inmunología , Femenino , Humanos , Intestinos/patología , Pulmón/inmunología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pruebas de Función RespiratoriaRESUMEN
BACKGROUND: The molecular mechanisms that underlie colorectal cancer (CRC) include microsatellite instability (MSI), chromosomal instability, and the CpG island methylator phenotype. There is evidence to suggest that CRC incidence varies among different ethnic populations worldwide. The authors of this report hypothesized that environmental factors and lifestyle differences among various ethnic groups may differentially influence the epigenetic regulation of tumor suppressor genes in CRC. METHODS: In the current study, microdissection and DNA extraction were performed on 128 samples of CRC from Israeli patients (85 Jews and 43 Arabs). MSI analysis, mutL homolog 1 (MLH1) and mutS homolog 2 (MSH2) protein expression levels, and MLH1 promoter methylation were investigated by combined bisulfite restriction analysis. The v-raf murine sarcoma viral oncogene homolog B1 (BRAF) valine-to-glutamic acid mutation at residue 600 was investigated by direct DNA sequencing. RESULTS: High MSI (MSI-H), MLH1 methylation, and BRAF mutations were observed in 11.6%, 9.4%, and 23.5% of Jews, respectively, and in 16.2%, 17.6%, and 20.9% of Arabs, respectively (P value nonsignificant). MLH1 promoter methylation was observed in 22.6% of microsatellite-stable (MSS) tumors and in 53.8% of MSI-H tumors (P < .015). Extensive methylation (covering both 5' and 3' promoter regions) was present in all MSI-H tumors with loss of MLH1 expression. BRAF mutation was observed in 15.6% and 46.1% of MSS tumors and MSI-H tumors, respectively (P < .007). BRAF mutation was observed in 66%, 22.2%, and 14.7% of patients who had tumors with extensive MLH1 promoter methylation, methylation of the 5' region alone, or without methylation, respectively (P < .006). CONCLUSIONS: There was no difference in molecular signatures examined between Jewish and Arab patients with CRC in Israel. Extensive promoter methylation was associated with MLH1 inactivation, MSI, and BRAF mutation.
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Proteínas Adaptadoras Transductoras de Señales/genética , Neoplasias Colorrectales/etnología , Neoplasias Colorrectales/genética , Inestabilidad de Microsatélites , Mutación/genética , Proteínas Nucleares/genética , Regiones Promotoras Genéticas/genética , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Anciano , Árabes/genética , Neoplasias Colorrectales/diagnóstico , Islas de CpG , Metilación de ADN , Análisis Mutacional de ADN , Femenino , Humanos , Técnicas para Inmunoenzimas , Israel , Judíos/genética , Masculino , Homólogo 1 de la Proteína MutL , Proteínas Nucleares/metabolismo , Fenotipo , Reacción en Cadena de la Polimerasa , Proteínas Proto-Oncogénicas B-raf/metabolismoRESUMEN
Capsule endoscopy was launched at the beginning of this millennium and has since become a well-established tool for evaluating the entire small bowel for manifold pathologies. CE far exceeded our early expectations by providing us with a tool to establish the correct diagnosis for such elusive gastrointestinal conditions as obscure gastrointestinal bleeding, Crohn's disease, polyposis syndrome and others. Recent evidence has shown CE to be superior to other imaging modalities - such as small bowel follow-through X-ray, colonoscopy with ileoscopy, computerized tomographic enterography, magnetic resonance enteroclysis and push enteroscopy--for diagnosing small bowel pathologies. Since the emergence of CE, more than 650,000 capsules have been swallowed worldwide, and more than 700 peer-reviewed publications have appeared in the literature. This review summarizes the essential data that emerged from these studies.
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Endoscopía Capsular , Enfermedad de Crohn/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Enfermedades Intestinales/diagnóstico , Endoscopía Capsular/métodos , Endoscopía Capsular/tendencias , Contraindicaciones , HumanosRESUMEN
BACKGROUND: The Sightline ColonoSight (CS) colonoscopy system presents 3 technologic advances: (1) disposable components protect the reusable parts from contact with colonic contents, eliminating the need for disinfection between procedures, (2) an air-pressure-powered engine assists in colonoscope advancement, (3) light emitting diode (LED) illumination eliminates the need for fiber optics and an external light source. OBJECTIVES: To study the operation, performance, and safety of the Sightline CS colonoscopy system. DESIGN: The system was tested during colonoscopy in animals and in human pilot studies. An in vitro dye diffusion test, and bacterial cultures (obtained after using the colonoscope in animals and humans) were performed to ascertain the protective integrity of the disposable components. SETTING: Animal centers, hospitals in Israel and Italy, and office endoscopy centers in the United States. PATIENTS: Thirty-three volunteers and 145 patients who required a colonoscopy for various indications. INTERVENTIONS: Colonoscopy, polypectomy, biopsy, and coagulation. MAIN OUTCOME MEASURES: Complications, system function, cecal intubation, and colonoscopy time. RESULTS: The Sightline CS system performed well during a colonoscopy in 19 animals and 178 patients, without complications. Dye studies and bacterial cultures showed no transfer of dye molecules or bacterial organisms across the protective, disposable components. LIMITATIONS: This is an observational pilot study, with no comparative group. CONCLUSIONS: The new Sightline CS colonoscopy system performed well. The disposable components eliminated the need for disinfection of the colonoscope between procedures. Advancement of the colonoscope in the colon was helped by self propulsion of the instrument affected by an air-pressure-powered engine. LED illumination eliminated the need for fiber optics and an external light source.
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Colonoscopios , Adolescente , Adulto , Anciano , Animales , Colonoscopía/métodos , Equipos Desechables , Diseño de Equipo , Femenino , Tecnología de Fibra Óptica , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Ovinos , PorcinosRESUMEN
AIM: To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. METHODS: We conducted a retrospective, blinded (to the type of preparation) review of 100 CE studies, 50 with no preparation with prokinetics from one medical center (Group A) and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B). Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. RESULTS: The erythromycin group had a slightly shorter gastric transit time (21 min vs 28 min, with no statistical significance). SB transit time was similar for both groups (all P > 0.05). Total transit time was almost identical in both groups. The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37). Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P > 0.05). CONCLUSION: Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.
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Endoscopía Capsular/métodos , Eritromicina/farmacología , Tránsito Gastrointestinal/efectos de los fármacos , Intestino Delgado/patología , Adulto , Anciano , Enfermedad de Crohn/patología , Enfermedad de Crohn/fisiopatología , Femenino , Hemorragia Gastrointestinal/patología , Hemorragia Gastrointestinal/fisiopatología , Humanos , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/patología , Enfermedades Intestinales/fisiopatología , Intestino Delgado/efectos de los fármacos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Macroamylasemia is a biochemical disorder characterized by an elevated serum amylase activity resulting from the circulation of a macromolecular complex of amylase with a serum component, often an immunoglobulin. The increased molecular weight of this complex prevents the normal renal excretion of the enzyme. A few cases of celiac patients with macroamylasemia have been published in whom the biochemical disorder disappeared after treatment with a gluten-free diet.
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Adenocarcinoma/radioterapia , Endoscopía Capsular , Ileítis/diagnóstico , Mucosa Intestinal/efectos de la radiación , Metástasis Linfática/radioterapia , Proctitis/diagnóstico , Traumatismos por Radiación/diagnóstico , Neoplasias del Cuello Uterino/radioterapia , Anciano , Anemia Ferropénica/etiología , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Ileítis/patología , Ileítis/cirugía , Mucosa Intestinal/patología , Melena/etiología , Proctitis/patología , Proctitis/cirugíaRESUMEN
Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well-established tool for evaluating the entire small bowel for manifold pathologies. CE far exceeded our early expectations by providing us with a tool to establish the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohn's disease, polyposis syndrome, and others. Recent evidence has shown CE to be superior to other imaging modalities, such as small bowel follow-through X-ray, colonoscopy with ileoscopy, computerized tomographic enterography, magnetic resonance enteroclysis, and push enteroscopy, for diagnosing small bowel pathologies. Gastroenterologists would prefer the convenience of a single capsule that can create images of the area from the oral cavity to the anal canal in one 'shot'. Because of anatomic and physiologic differences in the GI tract, however, it may not be possible to use the same capsule and so we would need a different one for each organ. In addition to the pioneer small bowel capsule, there is now an esophageal capsule, and a colonoscopy capsule will soon be available. The ideal CE should be capable of performing a biopsy or carrying out an online analysis (an 'optical' biopsy) and 'stop' bleeding by an epinephrine injection, a heat probe, argon plasma coagulation, etc. The ultimate capsule would include special detectors for white blood cells, and it would check oncological markers (e.g. CEA, CA 19-9), perform serology tests (e.g. antiendomysial, IgE), and measure various cytokines, pH levels, temperature and pressure, as well as deliver drugs. The capsule's motility feature in the small bowel may open a window to study the pathophysiology of relatively elusive medical entities, such as irritable bowel syndrome. The optimal capsule needs to contain an automatic computerized system for automatic detection of pathologies, such as that present in the ECG-Holter recording, in order to overcome the drawback of time-consuming viewing. Our dream is that endoscopists will be able to 'control and steer' the CE, as they are able to do in standard endoscopy. This would mean being able to maintain the capsule steady in a selected area and hold the view in order to have more time to examine the opposite wall of the bowel. In conclusion, future gastroenterologists will have a number of CEs from which to choose, according to the purpose of the evaluation, whether it be diagnostic and/or therapeutic. Just as the idea of a swallowed capsule taking images as it travels along the human anatomy was once in the realm of sheer fantasy, we have every reason to believe that the ultimate CE will become a reality in the not far distant future.
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Endoscopía Capsular , Endoscopios en Cápsulas , Humanos , Enfermedades Intestinales/diagnóstico , Intestino Delgado/patologíaRESUMEN
The purpose of this study was to examine the effect of age and selected indications for capsule endoscopy on small bowel transit times. Data on 67 clinical studies (790 subjects with different gastrointestinal pathologies [49.5% males; mean age, 51.9 +/- 18.33 years; range, 18-91 years] and 87 healthy volunteers) were retrieved from the company (Given Imaging, Ltd.)-sponsored database. All subjects swallowed the PillCam SB Capsule after a 12-hr fast. The capsule reached the cecum in all 877 participants. Indications for referral for capsule endoscopy were as follows: 372 obscure gastrointestinal bleeding, 96 suspected Crohn's disease, 65 celiac disease, 54 irritable bowel syndrome, and 116 familial adenomatous polyposis, intestinal lymphoma, or ulcerative colitis. One group consisted of patients <40 years old (n = 235), and the other patients 40 years old (n = 555). The younger group, volunteers, and Crohn's disease patients had significantly shorter small bowel transit times than the others (P < 0.001). Gastric emptying indirectly influenced capsule transit time.
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Endoscopía Capsular , Bases de Datos como Asunto , Tránsito Gastrointestinal/fisiología , Enfermedades Intestinales/diagnóstico , Intestino Delgado/fisiopatología , Selección de Paciente , Derivación y Consulta/organización & administración , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Intestinales/fisiopatología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios RetrospectivosAsunto(s)
Carcinoma in Situ/diagnóstico , Cistadenocarcinoma Mucinoso/cirugía , Neoplasias Pancreáticas/diagnóstico , Adulto , Carcinoma in Situ/cirugía , Diagnóstico Diferencial , Endosonografía , Femenino , Humanos , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We compared exhaled breath condensate (EBC) and induced sputum (IS) for assessing inflammation in pulmonary diseases in patients with obstructive lung disease (n = 20), persistent cough >6 months (n = 20), interstitial lung disease (n = 25) and controls (n = 10). EBC was collected by suspending a Teflon perfluoroalkoxy tube installed in an ice-filled container and connected to a polypropylene test tube. IS was recovered after 20' inhalation of 3% saline with an ultrasonic nebulizer, and 300 cells were differentially counted in cytospin Giemsa-stained slides. H(2)0(2) was measured by a method based on oxidation of phenolsulfonphthalein (phenol red) mediated by horseradish peroxidases and H(2)0(2). Pulmonary function tests were performed by conventional methods. H(2)0(2) levels in EBC and % eosinophils in IS were significantly different between groups. A positive and significant correlation was found between % eosinophils in IS and the levels of H(2)0(2) in EBC for each group and for all patients combined.
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Asma/diagnóstico , Pruebas Respiratorias/métodos , Tos/diagnóstico , Eosinófilos , Peróxido de Hidrógeno/análisis , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Esputo/citología , Adulto , Anciano , Asma/sangre , Asma/fisiopatología , Biomarcadores/análisis , Tos/sangre , Tos/fisiopatología , Espiración , Femenino , Humanos , Recuento de Leucocitos , Enfermedades Pulmonares Intersticiales/sangre , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria , Índice de Severidad de la EnfermedadRESUMEN
Reusable and disposable biopsy forceps are both widely available for use in gastrointestinal endoscopy units. Biopsy forceps have design and material features that may interfere with cleaning, and reusable devices must be designed to function safely and effectively following sterilization in a healthcare setting. During the last decade, endoscopic accessories have evolved from reusable to disposable in many parts of the world. Although use of disposable devices helps reduce the potential risk of cross-contamination and spread of infection, there remains the factor of cost. Major concerns for reuse of endoscopic accessories center on two main areas: sterility, and the capability of the equipment to perform its function satisfactorily after repeated uses and sterilizations. Reusable biopsy forceps perform a designated number of procedures, thus becoming more cost-effective than disposable forceps, which are impossible to clean and sterilize. The potential risk of infectious disease transmission must be taken into account. There is also the consideration that reprocessing of disposable forceps may damage or destroy the fragile devices.
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Equipos Desechables , Endoscopios Gastrointestinales , Biopsia/instrumentación , Diseño de Equipo , Equipo Reutilizado , HumanosRESUMEN
BACKGROUND: Men and postmenopausal women with iron deficiency anemia are routinely evaluated to exclude a gastrointestinal source of suspected internal bleeding. Iron deficiency anemia in premenopausal women is often treated with simple iron replacement under the assumption that the condition is due to excessive menstrual blood loss. OBJECTIVES: To determine the yield of endoscopy evaluations in premenopausal women with iron deficiency anemia. METHODS: Upper and lower gastrointestinal endoscopic examinations were conducted in 45 premenopausal women with iron deficiency anemia not related to gynecologic or nutritional causes. RESULTS: Forty-three of the 45 women fulfilled the entry criteria and were enrolled. Their mean age was 35 +/- 15 years and their mean hemoglobin level 9.3 +/- 2.3 g/dl. Twenty-eight upper gastrointestinal lesions were demonstrated in 24 of the 43 patients (55.8%): erosive gastritis in 12 (27.9%), erosive duodenitis in 4 (9.3%), erosive esophagitis in 3 (7.0%), hiatus hernia (with Cameron lesions) in 3 (7.0%), active duodenal ulcer in 1 (2.3%) and hyperplastic polyp (10 mm) in 1 (2.3%). Five lower gastrointestinal lesions were detected in 5 patients (16.3%): 2 (4.6%) had adenocarcinoma of the right colon, 2 (4.6%) had pedunculate adenomatous polyp > 10 mm, and 1 (2.3%) had segmental colitis (Crohn's disease). One patient (2.3%) had pathologic findings in both the upper and lower gastrointestinal tracts. CONCLUSIONS: Our findings of a gastrointestinal source of chronic blood loss in 28 of 43 premenopausal women with iron deficiency anemia (65.1%) suggest that this population will benefit from bi-directional endoscopic evaluation of the gastrointestinal tract.
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Anemia Ferropénica/diagnóstico , Endoscopía Gastrointestinal , Hemorragia Gastrointestinal/complicaciones , Premenopausia , Adolescente , Adulto , Factores de Edad , Anemia Ferropénica/etiología , Enfermedad Crónica , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND/AIMS: To compare the current differences with our earlier findings on the incidence and locations of colorectal cancer (CRC) among Israeli-born Jews and Arabs living within the same central coastal region in Israel. METHODS: Data on demographics and the incidence and locations of malignancies were retrieved from hospital files of pathology-diagnosed patients with CRC throughout 1997-2003 and compared with equivalent data from 1988 to 1996. RESULTS: Of the 624 patients recently diagnosed as having CRC, 562 (90.1%) were Jews and 62 (9.9%) were Arabs (p < 0.001). The average age of the entire cohort was significantly lower since our earlier study (72.9 +/- 12.5 compared to 67.9 +/- 12.7 years, p < 0.0001). The Jewish patients were significantly younger (p < 0.0001) but the Arab patients were not. The percentage of the adenocarcinoma being located in the right colon was significantly lower (p < 0.0006) and significantly higher in the rectum (p < 0.008). The reverse was true among the Jewish patients, but not significantly. CONCLUSIONS: Both study groups were younger than those in our earlier study. The lower incidence of CRC among the Arab patients persisted over time, but the location of their adenocarcinoma changed significantly. The increased incidence of CRC in 'westernized' countries is reflected in the Jewish but not the Arab community.
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Árabes/etnología , Neoplasias Colorrectales/etnología , Judíos/etnología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por SexoRESUMEN
Germline mutations in DNA mismatch repair (DNA-MMR) genes, mainly hMlh1 and hMsh2, underlie Hereditary Non-Polyposis Colorectal Cancer (HNPCC). Germline hMSH6 gene mutations have been reported in a small subset of HNPCC families. In the present study, ethnically diverse individuals with HNPCC and HNPCC-like features were genotyped for hMsh6 germline mutations using exon-specific PCR, DGGE, and DNA sequencing. The study encompassed 92 individuals representing 88 unrelated families who were previously analyzed for Msh2 and Mlh1 mutations: Jewish Ashkenazim (n = 44), non-Ashkenazim (n = 27), Israeli Moslem-Arab (n = 15), Druze (n=3), and Cypriot non-Jews (n = 3). Of the study population, 71 had colon cancer (CRC), mean age at diagnosis was 50.9+/-13.2 years (range 16-73 years), 5 had endometrial cancer (two with concurrent CRC), (mean 43.6+/-3.26 years, range 38-45 years), and unaffected individuals (n = 18) were first degree relatives within HNPCC families and were genotyped at a mean age of 48.3+/-11.7 years (range 30-69 years). Of the 92 individuals analyzed, none showed a truncating hMsh6 mutation, and 6 (6.6%) harbored one of three germline missense mutations: a previously reported one (V878A), and two novel mutations (V509A, S227I). The pathogenic significance of these three missense mutations is yet unclear. In addition, 5 polymorphisms were detected, 2 of which were novel. We conclude that the rate of pathogenic hMsh6 mutations in HNPCC families of Jewish and Mediterranean origin is low, and that mutations in other genes probably account for the phenotype in these families.