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PubMed1987

Capsule thickness of cataractous lenses with and without exfoliation syndrome.

Lens capsule thickness was measured in 105 cataractous lenses with and without exfoliation syndrome. The lenses were removed by intracapsular cryoextraction. Forty lenses (38%) showed exfoliation, while 65 (62%) were exfoliation negative. Thickness values were measured by light microscopy from the central anterior capsule, central posterior capsule and from the equator. The mean thickness values were for the central anterior capsule 8.2 +/- 3.2 mu, for the central posterior capsule 3.2 +/- 1.4 and for the equator 3.9 +/- 1.3. There was no statistical difference between the exfoliation-positive and exfoliation-negative lenses. The capsule thickness varied greatly throughout the present material. The highest value, 22.4 mu, was measured from an exfoliation-negative central anterior lens capsule of a male patient aged 33 years. The lowest value, 0.6 mu, was measured from an exfoliation-positive central posterior capsule of a male patient aged 64 years. The central posterior capsule is the thinnest area of the lens capsule. The findings call for great caution in polishing the posterior capsule during extracapsular cataract surgery. The higher complication rate in eyes with exfoliation syndrome cannot be explained by thinner lens capsules but rather on the more friable zonules.

Adult↗

PubMed2000

Volatility of radiopharmacy-prepared sodium iodide-131 capsules.

OBJECTIVE: The aims of this study were to quantify the extent of volatilization from 131I-NaI therapeutic capsules prepared in a centralized radiopharmacy and to quantify the amount of volatile 131I released from a dispensing vial containing a compounded 131I-NaI therapy capsule. METHODS: Therapy capsules were prepared by injecting 131I oral solution into capsules containing anhydrous dibasic sodium phosphate. Volatilized activity was obtained by filtering air drawn across samples that were placed open on the bottom of a sample holder cup. Volatile 131I was captured by filtering it through 3 triethylenediamine-impregnated carbon cartridge filters, arranged in series. To quantify the amount of volatile 131I released from a dispensing vial during a simulated patient administration, a vial containing a compounded 131I therapy capsule was opened inside a collapsible plastic bag and all the air was drawn across TEDA-impregnated carbon cartridge filters. RESULTS: The 370-MBq (10-mCi) 131I capsules from the first part of the experiment released an average of 0.035% (SD 0.031%) of the capsule activity on the first day, 0.012% (SD 0.002%) on the second day, and 0.012% (SD < 0.001%) for days 3 through 5. The 37-MBq (1-mCi) 131I capsules released an average of 0.058% (SD 0.025%) on the first day, 0.029% (SD 0.009%) on the second day, and 0.020% (SD 0.004%) on the third day. The activity released from the vial during a simulated patient administration was 0.00093% of the 131I capsule activity. CONCLUSION: The amount of 131I, which volatilized daily from the exposed therapy capsules, was a small percentage of the capsule activity. The volatile 131I that would be released during a patient administration was much less than the activity that volatilized from the exposed therapy capsules.

Humans↗

PubMed2003

Biocompatibility and surface structure of chemically modified immunoisolating alginate-PLL capsules.

Grafting of encapsulated living cells has the potential to cure a wide variety of diseases. Large-scale application of the technique, however, is hampered by insufficient biocompatibility of the capsules. A major factor in the biocompatibility of capsules is inadequate covering of the inflammatory poly-L-lysine (PLL) on the capsules' surface. In the present study, we investigate whether tissue responses against alginate-PLL capsules can be reduced by crosslinking the surface of the capsules with heparin or polyacrylic acid. Our transplant study in rats shows a tissue response composed of fibroblasts and macrophages on alginate-PLL-alginate and alginate-PLL-heparin capsules that was completely absent on alginate-PLL-polyacrylic acid capsules. Atomic force microscopy analyses of the capsules demonstrates that the improved biocompatibility of alginate-PLL-capsules by polyacrylic acid coating should not only be explained by a more adequate binding of PLL but also by the induction of a smoother surface. This study shows for the first time that biologic responses against capsules can be successfully deleted by chemically crosslinking biocompatible molecules on the surface of alginate-PLL capsules.

Acrylic Resins↗

PubMed1987

Equine zona pellucida and capsule: some physicochemical and antigenic properties.

The capsule which surrounds the pre-attachment equine embryo has been compared with the zona pellucida (zp) that it replaces, as well as with the rabbit blastocyst coverings, by means of physicochemical and immunological methods. Trypsin solution at pH varying between 7.5 and 9.0 completely solubilized the capsule, as did Na borohydride. However, solutions of pH 2.0 or 12.0, urea, high temperature (65 degrees C, 60 min or 80 degrees C, 30 min), mercaptoethanol and dithiothreitol were able to solubilize the zp but not the capsule at the concentrations used. Indirect immunofluorescence on cryostat sections and whole mounts of fresh or frozen-thawed material showed that 1) common antigens are shared by equine, porcine and bovine zp; 2) day 7 to day 15.5 capsule reacted with anti-capsule-serum but not with anti-zp-serum except for a few patches on the surface of the capsule; 3) anti-capsule-serum, but not anti-zp-serum, reacted with the capsular material recovered along with a broken day 27.5 conceptus; 4) anti-capsule-serum does not react with rabbit blastocyst coverings; 5) anti-capsule antibodies can be absorbed from the anti-capsule-serum by uterine proteins from either pregnant or non-pregnant mares; and 6) the capsule does not contain mouse laminin-like material.

Animals↗

PubMed1989

Comparative trial between two soft jelly capsules containing nonoxynol as spermicidal contraceptives.

The rupture time of two types of soft jelly capsules (treated and non-treated) containing Nonoxynol-9 after its vaginal insertion was investigated in 96 women. Subjects were allocated in four study groups: Group I (n = 24), women with clinical vaginal infection; Group II (n = 24), subjects without vaginal infection; Group III (n = 24), patients with vaginal infection; and Group IV (n = 24), women without vaginal infection. Groups I and II received the treated capsules, and Groups III and IV the non-treated capsules. The capsules remained in the vagina for 2.5 to 5 minutes. The weight of the capsules was measured before insertion and after their extraction. Additionally, vaginal pH and distribution of the compound were assessed. The results disclosed that in Groups I, III and IV, the capsules ruptured within 2.5 minutes, whereas in Group II the rupture did not occur until 3 minutes. The largest number of non-ruptured capsules was observed in Group II. The major capsule weight loss occurred at minute 5 in most of the groups. The conditions currently observed in cases of non-ruptured capsules were: alkaline pH, multiparity and vaginal dryness. The vaginal distribution of the compound was observed at its upper portion. In women with vaginal infections, there were more cases of rupture and a significant weight loss between the treated capsules than the non-treated capsules. Further postcoital tests are required to assess its effectiveness.

Administration, Intravaginal↗

PubMed2002

Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: Results of a pilot study.

BACKGROUND: A video capsule has been developed to acquire photographic images of the small intestine during normal peristaltic motion. METHODS: Patients between 21 and 80 years of age referred for enteroscopy because of obscure GI bleeding were offered entry into a trial in which they would undergo both capsule endoscopy and subsequent push enteroscopy. Results of capsule examinations were compared with push enteroscopy findings. Capsule endoscopy was performed with the Given M2A video capsule system. RESULTS: Twenty-one patients (12 women, 9 men, average age 61 years) were enrolled, all of whom completed the study. A bleeding site was found in 11 of 20 patients during capsule endoscopy. No additional intestinal diagnoses were made by enteroscopy. The yield of push enteroscopy in the evaluation of obscure bleeding was 30% (6/20), the yield of capsule endoscopy 55% (11/20). This difference did not reach statistical significance (p = 0.0625). Capsule endoscopy found a distal source of bleeding in 5 of 14 patients who had normal push enteroscopic examinations. Patients preferred capsule endoscopy to enteroscopy. CONCLUSIONS: This pilot study demonstrates that capsule endoscopy provides excellent visualization of the small intestine, is well tolerated by patients, and is safe. Capsule endoscopy identified small intestinal bleeding sites beyond the range of push enteroscopy.

Adult↗

PubMed1999

Fibrous membrane formation at the capsular margin in capsule contraction syndrome.

PURPOSE: To determine whether the pathogenesis of capsule contraction syndrome involves the outgrowth of the fibrous membrane from the anterior capsule margin. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, and the Ando Eye Clinic, Kanagawa, Japan. METHODS: A retrospective review of medical records and slitlamp photographs was conducted in 12 eyes (10 patients) that had required treatment for a narrowed anterior capsule opening after cataract surgery. All patients had had continuous curvilinear capsulorhexis and phacoemulsification with implantation of an intraocular lens in the capsular bag. Specimens of surgically removed fibrous membrane were examined by histopathological methods. RESULTS: Fibrous membrane on the inner surface of the anterior capsule and the linear folds of the anterior capsule were present in each eye. In 10 eyes of 8 patients, the fibrous membrane was on the outer surface of the anterior capsule and covered the capsular folds at its margin. Pathological study showed that this fibrous membrane consisted of the flattened lens epithelial cells that proliferated on the inner and outer surfaces of the shrunken anterior capsule. The outgrowth of this membrane from the margin of the anterior capsule to the center of the opening of the anterior capsule was noted. CONCLUSION: In this study, capsule contraction syndrome involved contraction of the fibrous membrane as well as its outgrowth from the capsule margin.

Actins↗

PubMed2004

Demonstration of substance P, calcitonin gene-related peptide, and protein gene product 9.5 containing nerve fibers in human cervical facet joint capsules.

STUDY DESIGN: Human cervical facet joint capsules were evaluated by immunohistochemistry. OBJECTIVES: To study the neuropeptide innervation of the cadaveric cervical facet joint capsules. SUMMARY OF BACKGROUND DATA: Various clinical and biomechanical studies indicate a role for cervical facet joint capsules in the etiology of neck pain. However, studies on innervation of these capsules are very limited. There is also a dearth of studies on the neuropeptide nature of this innervation. METHODS: Facet joint capsules harvested from unembalmed cadavers were studied by the avidin biotin peroxidase method for the presence of nerve fibers. Neuropeptide innervation was investigated by using antisera to substance P and calcitonin gene-related peptide. Antisera to protein gene product 9.5 (PGP 9.5), a general neuronal marker, were also used. RESULTS: In a study of 12 human cervical facet joint capsules, short segments of substance P were observed in 6 capsules, while fibers reactive to calcitonin gene-related peptide were demonstrated in 7 capsules. Nerve fibers immunoreactive to protein gene product 9.5 were also observed in 9 of the 14 capsules studied. Protein gene product 9.5 reactive fibers were the most extensively distributed fibers, observed as bundles and also as single fibers. CONCLUSIONS: An abundance of protein gene product 9.5 reactive nerve fibers indicates an extensive innervation of the cervical facet joint capsules. The presence of substance P and calcitonin gene-related peptide reactive nerve fibers in a population of these lends credence to cervical facet joint capsules as a key source of neck pain.

Aged↗

PubMed2005

Radiological studies reveal radial differences in the architecture of the polysaccharide capsule of Cryptococcus neoformans.

The polysaccharide capsule of the pathogenic fungus Cryptococcus neoformans is an important virulence factor, but relatively little is known about its architecture. We applied a combination of radiological, chemical, and serological methods to investigate the structure of this polysaccharide capsule. Exposure of C. neoformans cells to gamma radiation, dimethyl sulfoxide, or radiolabeled monoclonal antibody removed a significant part of the capsule. Short intervals of gamma irradiation removed the outer portion of the cryptococcal capsule without killing cells, which could subsequently repair their capsules. Survival analysis of irradiated wild-type, acapsular mutant, and complemented mutant strains demonstrated that the capsule contributed to radioprotection and had a linear attenuation coefficient higher than that of lead. The capsule portions remaining after dimethyl sulfoxide or gamma radiation treatment were comparable in size, 65 to 66 microm3, and retained immunoreactivity for a monoclonal antibody to glucuronoxylomannan. Simultaneous or sequential treatment of the cells with dimethyl sulfoxide and radiation removed the remaining capsule so that it was not visible by light microscopy. The capsule could be protected against radiation by either of the free radical scavengers ascorbic acid and sorbitol. Sugar composition analysis of polysaccharide removed from the outer and inner parts of the capsule revealed significant differences in glucuronic acid and xylose molar ratios, implying differences in the chemical structure of the constituent polysaccharides. Our results provide compelling evidence for the existence of two zones in the C. neoformans capsule that differ in susceptibility to dimethyl sulfoxide and radiation and, possibly, in packing and composition.

Antibodies, Monoclonal↗

PubMedDate not supplied

Enteric-coated insulin capsules: a combination with or a replacement of oral hypoglycaemic drugs.

The hypoglycaemic effect of Eudragit S100 enteric-coated insulin capsules containing sodium salicylate as an absorption promoter, oral hypoglycaemic tablets sulphonylurea (e.g. doanil 5 mg) and metformin (e.g. glucophage 500 mg) was studied in hyperglycaemic beagle dogs. The effect of the combinations of insulin capsules + doanil, insulin capsules + glucophage and the combination of doanil + glucophage is also studied. The results show that the enteric-coated insulin capsules produced the same results as the glucophage tablets with respect to Cmax, AUC and relative hypoglycaemia. While, doanil tablets produced non significant lowering (P > 0.05) of Cmax and a significant less (P < 0.05) AUC compared to that produced by insulin capsules and lower (P < 0.001) RH compared to that of insulin capsules or glucophage tablets. The combination of glucophage and doanil tablets resulted in synergistic effect producing 59 +/- 9.27% reduction in plasma glucose levels by 4h and significantly higher (P < 0.001) AUC and RH compared to either of the tablets alone. The combination of insulin capsules and doanil tablets produced only 16% lowering in plasma glucose levels by 6h and significantly (P < 0.001) lower AUC and RH compared to the combination of glucophage + doanil. The combination of insulin capsules and glucophage tablets produced about 38% reduction in plasma glucose levels and significantly (P < 0.001) higher AUC and RH compared to either glucophage, doanil tablets or enteric coated insulin capsules alone. The results show that enteric-coated insulin capsules can be a replacement of either of the oral hypoglycemic drugs. In addition, the combination of the insulin capsules and glucophage tablets could be a good therapy to Type II diabetic patients that not controlled properly by oral hypoglycemic drugs.

Animals↗

PubMed1976

Fine structure of the avian muscle spindle capsule.

The capsule of the muscle spindle from the anterior and posterior latissimus dorsi muscles of the adult domestic chicken has been studied with the electron microscope. As in other species, two distinct portions of the spindle capsule are distinguished: an outer capsule and an inner capsule. The outer capsule is structurally similar to and continuous with the perineural epithelium. Outer capsule cells are noted by the abundance of pinocytotic vesicles and a network of 6-7-nm microfilaments. The disposition of these microfilaments is circumferential with respect to the longitudinal axis of the spindle. It is proposed that they may provide a contractile mechanism for the capsule which may be related to the over-all functioning of the spindle during movements of the muscle. The inner capsule is composed of a contiguous network of cells possessing long cytoplasmic processes which envelop the intrafusal fibers and their nerve endings in sensory equatorial regions of the spindle. These cells may elaborate the fibrillar and amorphous extracellular material found in periaxial spindle space. They also possess modified cilia with a "9+0" microtubular pattern. It is suggested that these cilia may behave as sensory transducers, relating fluid changes in the periaxial space to the intrafusal fiber nerve endings. Capillaries of the non-fenestrated variety commonly traverse the outer and inner portions of the capsule and are usually completely surrounded by tenuous overlapping processes of inner capsule cells. These findings suggest that the spindle capsule plays a role as a metabolically-active diffusion barrier to the entrance of substances from the external milieu.

Animals↗

PubMed1985

The ultrastructure of sensory nerve endings in the human knee joint capsule.

The ultrastructure of sensory nerve endings in the human knee joint capsule was studied. Three types of nerve endings were found: free nerve endings (FNE), Ruffini corpuscles and Pacini corpuscles. In the joint capsule, FNE are located below the synovial layer and within the fibrous layer near blood vessels. These nerve terminals derive from myelinated A delta-fibres or from unmyelinated C-fibres. Their structure is almost identical to FNE in human hairy and non-hairy skin. Ruffini corpuscles are present within the fibrous layer and the ligaments of the capsule in three variations: small Ruffini corpuscles without a capsule, small with a connective tissue capsule, and large Ruffini corpuscles with an incomplete perineural capsule. Their afferent axons are myelinated and measure 3-5 micron in diameter. Inside the corpuscle, nerve terminals are anchored in the connective tissue belonging to the fibrous layer or to the ligaments respectively. The presence of an incomplete perineural capsule depends on the structure of the surrounding connective tissue. In ligaments with collagenous fibrils oriented in a parallel fashion, the perineural capsule is well-developed and the Ruffini corpuscle resembles a Golgi tendon organ; in areas where the fibrils show no predominant orientation, Ruffini corpuscles lack a capsule. Small Pacini corpuscles are situated within the fibrous layer near the capsular insertion at the meniscus articularis or at the periost. They consist of one or several inner cores and a perineural capsule of 1-2 layers. Larger Pacini corpuscles with one or several inner cores and a perineural capsule consisting of 20-30 layers are found on the outer surface of the fibrous layer. The ultrastructure of these nerve endings is compared with the ultrastructure of articular receptors of various animals and with the ultrastructure of sensory nerve endings in the skin of several mammalian species including man.

Adult↗

PubMed2006

The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.

BACKGROUND: Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. METHODS: One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years. RESULTS: The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.

Adult↗

PubMed2004

Endoscopic placement of the capsule endoscope in children.

BACKGROUND: Capsule endoscopy provides a minimally invasive examination of the entire small bowel. However, some children and disabled adults may be unable to independently ingest the capsule. A new method for endoscopic placement of the capsule endoscope is described. METHODS: Consecutive children who required capsule endoscopy of the small bowel and who were unable to independently ingest the capsule were selected for endoscopic placement. A net retrieval catheter and a translucent ligation adaptor were used to hold and stabilize alignment of the capsule during endoscopic insertion into the distal duodenum. RESULTS: Eleven pediatric patients underwent successful endoscopic placement of a capsule endoscope in the duodenum without complication. One capsule migrated back into the stomach, where it remained for the life of the battery. CONCLUSIONS: Endoscopic placement of the capsule endoscope by using the described technique appears to be effective and safe. It facilitates capsule endoscopy in patients who are unable to independently ingest the capsule.

Adolescent↗

PubMed1998

Development of glia and blood vessels in the internal capsule of rats.

We have explored two aspects of internal capsule development that have not been described previously, namely, the development of glia and of blood vessels. To these ends, we used antibodies to glial fibrillary acidic protein (GFAP) and to vimentin (to identify astrocytes and to radial glia) and Griffonia simplicifolia (lectin; to identify microglia and blood vessels). Further, we made intracardiac injections of Evans Blue to examine the permeability of this dye in the vessels of the internal capsule during neonatal development. Our results show that large numbers of radial glia, astrocytes and microglia are not labelled with these markers in the white matter of the internal capsule until about birth; very few are labelled earlier, during the critical stages of corticofugal and corticopetal axonal ingrowth (E15-E20). The large glial labelling in the internal capsule at birth is accompanied by a dense vascular innervation of the capsule; as with the glia, very few labelled patent vessels are seen earlier. After intracardiac injections of Evans Blue, we find that the blood vessels of the internal capsule are not particularly permeable to Evans Blue. At each age examined (P0, P5, P15), blood vessels are outlined very clearly and there is no diffuse haze of fluorescence within the extracellular space, which is indicative of a leaky vessel. There are three striking differences between the glial environment of the internal capsule and that of the adjacent thalamus. First, the internal capsule is never rich with radial glial fibres (vimentin- and GFAP-immunoreactive) during development (except at P0), whereas the thalamus has many radial fibres from very early development (E15-E17). Second, astrocytes (vimentin- and GFAP-immunoreactive) first become apparent in the internal capsule (E20-P0) well before they do in the thalamus (P15). Third, the internal capsule houses a large transient population of amoeboid microglia (P0-P22), whereas the thalamus does not; only ramified microglia are seen in the thalamus. In summary, our results indicate that all three types of glia in the internal capsule are associated closely with the vasculature, suggesting they may play a role in the development of the blood-brain barrier among the vessels in this white matter region of the forebrain.

Animals↗

PubMed2000

A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions.

BACKGROUND & AIMS: Wireless capsule endoscopy is a new, painless method of imaging the entire small bowel. It has not been compared with push enteroscopy. We compared the sensitivity, specificity, and safety of capsule and push enteroscopy in detecting small-bowel lesions. METHODS: Nine to 13 radiopaque, colored beads (3-6 mm diameter) were sewn in random order inside 9 canine small bowels, half within the first meter, and confirmed on x-ray. After recovery, the number, order, and color of beads were assessed in 23 capsule enteroscopies and 9 push enteroscopies in a random order. The surgeons, push enteroscopists, capsule video interpreters, and pathologist were blinded to the others' findings. RESULTS: The capsules identified more beads than push enteroscopy (median, 6 [range, 2-9] vs. 3 [range, 2-6 beads]; P < 0.001). The sensitivity of the capsule was 64% compared with 37% for push enteroscopy. The specificity was 92% for capsule enteroscopy and 97% for push enteroscopy. The capsules identified significantly more beads beyond the reach of the push enteroscope (median, 4 [range, 2-7] vs. 0; P < 0.0001). Hair, ingested plastic, ulceration, submucosal swelling, and worms were clearly identified by the capsule. The capsules passed safely through the animals with no significant histologic findings. CONCLUSIONS: Wireless capsule endoscopy detected more abnormalities in the small bowel than push enteroscopy.

Animals↗

PubMed2003

Vascular capsule for telemetric monitoring of blood pressure.

PURPOSE: Development and experimental evaluation of an intravascular monitoring system for telemetric measurement of blood pressure and heart rate. MATERIALS AND METHODS: The monitoring system consists of an implantable silicone capsule (diameter 2.3 mm), containing a dedicated microchip with pressure sensors and signal-processing circuits as well as an antenna for wireless data and energy transfer using 6.78 MHz transponder technology. Three self-expanding legs at one end of the capsule served as a mechanism to lock the capsule at an arterial branch. A flow model, driven by a ventricular assist system, was used for testing and optimizing the implantation equipment, for checking the anchoring mechanism and for ensuring transmission of the measured pressure to the readout unit. In-vivo experiments were performed in 8 minipigs (weight 25 to 30 kg), with three capsules placed in each minipig via the femoral artery using a dedicated 8-F sheath/pusher system. Follow-up was by CT angiography for up to 6 months after implantation. RESULTS: Flow model tests revealed a maximum deviation of pressure and heart rate measurements of 5% from the reference measurements. Signal transmission was reliable over a distance of 3 to 4 cm. Fluoroscopically guided in-vivo implantation of the capsules was simple and straightforward. In arteries with a diameter of 5 to 6 mm, the capsules were permanently fixed with one or two legs interlocked in side branches and without occlusion within 6 months. Three capsules developed a small non-occlusive appositional thrombus attached to the downstream (leg) part of the capsule. CONCLUSION: Our in-vitro and in-vivo experiments demonstrate the feasibility of wireless transmission from a capsule with a sufficient resolution of the sensor output signals to determine blood pressure and pulse rate. As long as the vessel diameter is wide enough, arterial fixation of the capsule does not induce thrombotic occlusion of the parent artery. With respect to future clinical applications, further refinements of the transmission technology are needed to extend the transmission distance between capsule and reader antenna. The technology of intelligent implants has further implications, such as monitoring of other physiological parameters, and the design of a control loop, which may be used for therapeutic feedback.

Animals↗

PubMed2006

Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy.

BACKGROUND AND STUDY AIM: Video capsule endoscopy and push-and-pull enteroscopy (PPE), both allow a complete examination of the small bowel in patients with suspected intestinal disorders. Due to the invasiveness of PPE, indications should probably be selective. The aim of the present prospective study was to evaluate the outcome of an approach whereby capsule endoscopy was used to select patients in whom PPE was indicated. PATIENTS AND METHODS: 164 patients were included (90 men; age 54+/-18 years) with various indications for small-bowel investigation, such as obscure bleeding (n=88), suspected Crohn's (n=14) or celiac (n=12) disease, or known or strongly suspected localized diseases such as neoplasms (n = 18) for biopsy. Four patients with a suspected intestinal stenosis underwent PPE without prior capsule endoscopy. In the remaining 160 patients, who had a capsule endoscopy, PPE was selected if there were lesions requiring biopsy or angiodysplasias to be treated by argon plasma coagulation (APC). Regarding the insertion route, an anal PPE was indicated if the capsule transit time from ingestion to arrival at the lesion was >or= 75 % of the total time from ingestion to arrival at the cecum. After gut cleansing, PPE was performed with general anesthesia, and the small bowel was examined until the lesion was reached or the scope could not be advanced further. If the suspected lesion had not been reached, a second procedure was performed through the alternative route, under the same conditions. RESULTS: The diagnostic yield of capsule endoscopy was 75 %. According to the indications, 47 PPE procedures were performed in 42 patients, including 33 through the oral route, 4 through the anal route and 5 combined ones. Indications were: suspicion of intestinal tumor (n=13), celiac disease with chronic bleeding (n=4), suspicion of Crohn's disease (n=3), treatment of significant arteriovenous malformations (AVMs) (n=10), diffuse enteropathies (n=3), nonsteroidal anti-inflammatory drug (NSAID)-related conditions (n=2), and obscure digestive bleeding (n=3). Lesions detected by capsule endoscopy were reached by PPE in all but two cases. The positive predictive value (PPV) of capsule endoscopy to make a correct indication for PPE was 94.7 % and the negative predictive value (NPV) was 98.3 %. The PPV and NPV of a time index of > 0.75 to start via the anal route were 94.7 % and 96.7 %. No complications were observed and all patients were discharged the day after the procedure. Follow-up at 9 months showed that capsule endoscopy followed by PPE had positively influenced the management of 90.5 % of the patients. CONCLUSIONS: The use of capsule endoscopy as a filter for PPE results in effective management of patients with various intestinal diseases. Capsule endoscopy can also direct the choice of route of PPE; a time index of > 0.75 appears to reliably indicate an anal route so that a double procedure is required in only about 12 % of cases.

Adult↗