RESUMEN
BACKGROUND: Adequate colon preparation is essential for the quality and accuracy of colonoscopy and has a significant influence on related costs. The aim of this study was to assess the efficacy and safety of a novel attachable colon-cleaning device used during colonoscopies in porcine colon. METHODS: The ClearPath device consists of a multilumen extruded tube with channels for water irrigation and evacuation designed to allow the break up and removal of stool remnants during colonoscopy. Seven female domestic swine underwent several series of experiments in which partial bowel preparation followed by a sedated colonoscopy using the new device was performed. RESULTS: Between February 2008 and October 2008, a total of 57 colonoscopic procedures were conducted. The device enabled rapid cleaning of the partially prepared porcine colon with no immediate or delayed adverse consequences. CONCLUSIONS: Use of the ClearPath device was found to be a simple, reliable, and safe method for intraprocedural cleaning of partly prepared porcine colon. These experiments support a potential role for ClearPath in cleaning the colon in unprepared or poorly prepared human patients.
Asunto(s)
Colonoscopía/métodos , Irrigación Terapéutica/métodos , Animales , Colon , Colonoscopía/instrumentación , Femenino , Proyectos Piloto , Porcinos , Irrigación Terapéutica/instrumentaciónRESUMEN
BACKGROUND: Exaggerated reaction to insect bites, mainly to mosquitoes, is infrequently described in patients with chronic lymphocytic leukemia. Skin lesions usually appear months to years after the diagnosis of leukemia and are unrelated to laboratory findings, disease course, or therapy. OBSERVATIONS: We describe 8 patients with various hematologic disorders (chronic lymphocytic leukemia, acute lymphoblastic leukemia, acute monocytic leukemia, mantle-cell lymphoma, large-cell lymphoma, and myelofibrosis) who developed insect bite-like reaction. Although the clinical picture and the histological characteristics of the lesions were typical for insect bites, none of the patients actually had a history, course, or response to treatment suggestive of arthropod assaults. In 2 patients, the eruption preceded the diagnosis of the malignant neoplasm. The rash persisted for months to years and was resistant to therapies other than systemic corticosteroids. The 3 patients with chronic lymphocytic leukemia seemed to have a worse prognosis than expected for their disease. In 1, the polymerase chain reaction detected leukemic cells in the infiltrate. CONCLUSIONS: Insect bite-like reaction is an infrequent, disturbing, and difficult-to-treat nonspecific phenomenon in patients with hematologic malignant neoplasms. Since it may precede the hematologic disorder, oriented evaluation is warranted. We speculate that immunodeficiency plays a role in its pathogenesis; however, the exact pathogenesis and its prognostic implications await further studies.
Asunto(s)
Exantema/diagnóstico , Neoplasias Hematológicas/diagnóstico , Mordeduras y Picaduras de Insectos/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Adolescente , Anciano , Diagnóstico Diferencial , Exantema/patología , Femenino , Estudios de Seguimiento , Neoplasias Hematológicas/patología , Humanos , Mordeduras y Picaduras de Insectos/patología , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/patología , Leucemia Monocítica Aguda/diagnóstico , Leucemia Monocítica Aguda/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células del Manto/diagnóstico , Linfoma de Células del Manto/patología , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Recurrencia , Piel/patologíaRESUMEN
It has been shown that the glomerular filtration rate increases after a meat meal. We examined in humans whether enalapril, which has been shown to decrease glomerular capillary pressure in rats with chronic renal failure, could attenuate the renal response to a meat meal. Twelve healthy volunteers were studied after an oral protein load, 1.5 g/kg body weight, as lean cooked beef meat, and on a separate day, after eating the same meal with prior oral intake of enalapril. On the control day, creatinine clearance increased from 114.3 +/- 4.7 before the meal to 137.1 +/- 4.7 ml/min/1.73 m2 after the meal (p less than 0.001). On the enalapril intake day, creatinine clearance increased from 113.7 +/- 5.6 before the meal to 128.3 +/- 5.8 ml/min/1.73 m2 after the meal (p less than 0.01). However, the mean increase in creatinine clearance was lower on the enalapril intake than on the control day (14.0 +/- 4.3 vs. 21.0 +/- 4.1%, p less than 0.05). Mean arterial pressure before the meal was lower on the enalapril intake day than on the control day (76.2 +/- 3.5 vs. 84.2 +/- 3.6, p less than 0.01). Likewise, postprandial mean arterial pressure was lower on the enalapril day compared with the control day (69.9 +/- 2.8 vs. 78.5 +/- 3.7, p less than 0.01). We conclude that enalapril blunts the hyperfiltration which follows a meat meal.