The probiotic agent Escherichia coli M-17 has a healing effect in patients with IBS with proximal inflammation of the small bowel.
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Adult↗
Biomedical subjects
S N Adler
Publications and source records attributed to S N Adler.
PillCam ESO in esophageal studies: improved diagnostic yield of 14 frames per second (fps) compared with 4 fps.
BACKGROUND AND STUDY AIM: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. PATIENTS AND METHODS: 42 patients with GERD symptoms and eight patients with a history of Barrett's esophagus had an esophagogastroduodenoscopy (EGD). All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4-fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14-fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett's esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. RESULTS: The 4-fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 %) and 6/8 cases of Barrett's esophagus (sensitivity 75 %). The 14-fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett's esophagus (sensitivity 100 %). The total diagnostic miss rate in the 4-fps group was 5/27 (18 %) whereas the diagnostic miss rate in the 14-fps group was 0/23 (0 %) P < 0.02). The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 %) in the 4-fps group and in 20/25 patients (80 %) in the 14-fps group ( P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 %) by the 4-fps device and in 19/25 (76 %) by the 14-fps device ( P < 0.01). The superiority of the 14-fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14-fps PillCam this means one image transmitted per 3-cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. CONCLUSIONS: Capsule endoscopy using the 14-fps PillCam ESO showed a greater sensitivity than that of the 4-fps device for identifying GERD. The 14-fps PillCam ESO was statistically superior to the 4-fps device in visualizing the opening of the UES and the entirety of the esophagus.
Endoscopes, Gastrointestinal↗
Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study.
BACKGROUND AND STUDY AIMS: Population-based screening for colorectal cancer is widely recommended, with conventional colonoscopy considered to be the preferred diagnostic modality. However, compliance with screening colonoscopy is low and manpower capacity is limited. Capsule endoscopy might therefore represent a desirable alternative strategy. PATIENTS AND METHODS: The PillCam Colon capsule endoscope was prospectively tested in a multicenter setting. The indications for endoscopy in the enrolled patients included colorectal cancer screening (43 %), postpolypectomy surveillance (26 %), and lower gastrointestinal signs and symptoms (31 %). Study subjects underwent colon preparation and then ingested the capsule on the morning of the examination, with conventional colonoscopy being performed the same day. The PillCam Colon capsule findings were reviewed by three experts in capsule endoscopy who were blinded to the conventional colonoscopy findings. RESULTS: A total of 91 subjects were enrolled in three Israeli centers (55 men, 36 women; mean age 57), and the results were evaluable in 84 cases. The capsule was excreted within 10 hours in 74 % of the patients and reached the rectosigmoid colon in the other 16 %. Of the 84 evaluable patients, 20 (24 %) had significant findings, defined as at least one polyp of 6 mm or more in size or three or more polyps of any size: 14/20 (70 %) were identified with the capsule and 16/20 (80 %) were identified by conventional colonoscopy. Polyps of any size were found in 45 patients, 34/45 (76 %) found by the capsule and 36/45 (80 %) by conventional colonoscopy. In comparison with conventional colonoscopy, false-positive findings on PillCam Colon capsule examination were recorded in 15/45 cases (33 %). There were no adverse events related to the capsule endoscopy. CONCLUSIONS: PillCam Colon capsule endoscopy appears to be a promising new modality for colonic evaluation. Further improvements in the procedure will probably increase capsule examination completion and polyp detection rates. Additional studies are needed to evaluate the accuracy of PillCam Colon endoscopy in other patient populations with different prevalence levels of colonic disease.
Adolescent↗
Combined endoscopic and surgical management of Mirizzi syndrome.
Mirizzi syndrome is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with or without a cholecystocholedochal fistula. This syndrome is a rare complication of cholelithiasis that accounts for 0.1% of all patients with gallstone disease. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with a preoperative diagnosis of type I Mirizzi syndrome that was confirmed and drained by endoscopic retrograde cholangiography (ERC), followed by subtotal cholecystectomy. A review of the literature covering its clinical presentation, diagnosis, and surgical treatment is also presented.
Cholangiopancreatography, Endoscopic Retrograde↗
A double stomach in an adult.
Gastric duplication cysts are uncommon congenital anomalies and are rarely diagnosed in adults. We present a unique case of a communicating type gastric duplication in a young woman with the multimodality imaging findings including barium examination, CT, and endoscopy. The morphological criteria for diagnosis of duplication cyst suggested pathogenetic mechanisms for its formation as well as clinical presentation. Associated pathologies are reviewed.
Adult↗
Barrett's esophagus in a young patient with Raynaud's phenomenon.
We describe a 12-year-old girl with Raynaud's phenomenon (RP) of 3 years' duration, who developed Barrett's esophagus with severe stricture. Barrett's esophagus complicating progressive systemic sclerosis has been reported in adult patients, but not in childhood. Barrett's esophagus following RP alone has not been reported, to the best of our knowledge, in any age group.
Barrett Esophagus↗
Reduction of aspirin-induced gastroduodenal mucosal damage with ranitidine.
A randomized, double-blind, placebo-controlled study was conducted to determine if concomitant administration of ranitidine, an H2-receptor antagonist, could reduce the gastroduodenal mucosal damage associated with short-term (3 day) aspirin therapy. Nineteen subjects received ranitidine 150 mg b.i.d. plus aspirin 650 mg q.i.d., and 21 received placebo b.i.d. plus aspirin 650 mg q.i.d. for 3 days. Gastric injury and duodenal injury were assessed separately on the basis of pre- and posttreatment endoscopic examinations. The ranitidine/aspirin group had significantly less mucosal damage in the stomach (p less than or equal to 0.01) and duodenum (p less than 0.05) than the placebo/aspirin group. There was no significant difference in mean serum salicylate levels between treatment groups after 3 days of aspirin consumption, indicating that the protective effect was achieved without compromising salicylate absorption.
Adolescent↗
Bleeding after liver biopsy in a patient with systemic mastocytosis and malabsorption.
Systemic mastocytosis, with its diffuse infiltration of mast cells into various organs, has resulted in intestinal malabsorption and bleeding diatheses. The pathophysiology underlying these phenomena is unclear, but may be related to the release of histamine and heparin containing mast cell granules. A patient with systemic mastocytosis had malabsorption and developed massive bleeding after percutaneous liver biopsy. Histologic involvement of skin, duodenum, rectum, liver, and bone marrow was documented. Mastocytosis should be considered in the differential diagnosis of malabsorption.
Aged↗
Massive hepatic hemorrhage associated with cardiopulmonary resuscitation.
We treated two patients with laceration of the liver that was precipitated by cardiopulmonary resuscitation (CPR) and recognized antemortem. Both patients had myocardial infarctions and had received heparin sodium therapy. They had excruciating abdominal pain and bled massively, resulting in hypovolemic shock. When severe abdominal pain associated with hypovolemic shock occurs in a patient who has received CPR, hepatic laceration, hematoma, or both should be considered. This is even more imperative to recognize in the patient who has received anticoagulation therapy.
Female↗
Adenocarcinoma of the small bowel. Clinical features, similarity to regional enteritis, and analysis of 338 documented cases.
A case of ileal adenocarcinoma is presented and the clinical features of adenocarcinoma of the small bowel are discussed. Special attention is paid to the differentiation of this tumor from Crohn's disease. Analysis of Connecticut Tumor Registry data on 338 cases of small intestinal adenocarcinoma occurring between 1935 and 1978 reveals a predilection for the elderly but no sex predominance (male/female = 0.965). Two hundred fifty-four patients were followed for at least 5 yr, and the overall (1935-1978) 5-yr survival rate was 17.3%. No improvement in survival has taken place in Connecticut over the past 40 yr.
Adenocarcinoma↗
Toxic shock syndrome in Oklahoma.
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Adolescent↗
Nonobstructive pyelonephritis initially seen as acute renal failure.
The triad of elevated SGOT and lactic dehydrogenase levels, positive blood and urine cultures, and acute renal failure was noted in a patient with severe pyelonephritis. Bilateral medullary necrosis was found on biopsy and at postmortem examination. These findings may help establish a prompt antemortem diagnosis.
Acute Kidney Injury↗