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PubMed2006

Capsule endoscopy in the pediatric patient.

Wireless capsule endoscopy represents an extraordinary technical innovation in diagnostic gastrointestinal endoscopy. As in adult patients, it opens new horizons that permit an accurate and noninvasive approach to identifying occult lesions in the small bowel in children and adolescents. A limitation in the pediatric age group is the size of the capsule, precluding its use in infants and small toddlers. In children unable to swallow the capsule, "front loading" the gastroscope to introduce it into the duodenum is a suitable alternative approach. Capsule endoscopy is highly useful to evaluate for inflammatory changes in patients suspected to have small bowel Crohn's disease in whom conventional imaging failed to confirm the diagnosis. It is now the method of first choice to assess for small bowel polyps or tumors, to find a source of blood loss in obscure intestinal bleeding, and for undiagnosed malabsorptive conditions such as intestinal lymphangiectasia. Capsule retention is the one major potential adverse effect of capsule endoscopy. In patients suspected to have a small bowel stenosis, consideration should be given to using the patency capsule prior to using the real videocapsule so as to decrease the risk of capsule retention.

Journal Article↗

PubMed2004

Bioequivalence, safety, and tolerability of imatinib tablets compared with capsules.

PURPOSE: Imatinib (Glivec) has been established as a highly effective therapy for chronic myeloid leukemia and gastrointestinal tumors. The recommended daily dosage of 400-600 mg requires simultaneous intake of up to six of the current 100-mg capsules. Due to the need to swallow multiple capsules per dose, there is a potential negative impact on treatment adherence; therefore, a new imatinib 400-mg film-coated tablet has been developed. To improve dosing flexibility, particularly with regard to the pediatric population and the management of adverse events, a scored 100-mg film-coated tablet has also been introduced. EXPERIMENTAL DESIGN: A group of 33 healthy subjects were randomly assigned to one of six treatment sequences, in which they received imatinib as 4 x 100-mg capsules (reference), 4 x 100-mg scored tablets (test), and 1 x 400-mg tablet (test). Blood sampling was performed for up to 96 h after dosing, followed by a 10-day washout period prior to the next sequence. After the third dosing, subjects were monitored to assess delayed drug-related adverse events. Pharmacokinetic parameters were assessed using concentration-time curves for plasma imatinib and its metabolite CGP74588. RESULTS: Median Tmax was 2.5 h for capsules and tablets. Mean AUC((0-inf)) values were 27,094, 26,081 and 25,464 ng.h/ml for 4 x 100-mg capsules, 4 x 100-mg tablets, and 1 x 400-mg tablets, respectively. Cmax values were 1748, 1638 and 1606 ng/ml, and t(1/2) values were 15.8, 15.9 and 15.7 h. The test/reference ratios for AUC((0-inf)), AUC((0-96) (h)), and C(max) were 0.98, 0.98 and 0.95 for 4 x 100-mg tablets versus 4 x 100-mg capsules, and 0.95, 0.95 and 0.92 for 1 x 400-mg tablet versus 4 x 100-mg capsules. The 95% confidence intervals were fully contained within the interval (0.80, 1.25). Eight mild and one moderate adverse event considered to be drug related were reported. These events showed no clustering by type of dosage form and were of little to no clinical significance. CONCLUSIONS: Film-coated 100-mg (scored) and 400-mg tablet dose forms of imatinib are bioequivalent to the commercial 100-mg hard-gelatin capsule, and are as safe and well tolerated.

Adolescent↗

PubMed2004

Relation between adhesive capsulitis and acromial morphology.

PURPOSE: The purpose of this study was to determine whether a relationship existed between primary adhesive capsulitis and acromial morphology. TYPE OF STUDY: Case control series. METHODS: Between January 1999 and June 2002, a total of 100 patients (104 shoulders) were diagnosed with adhesive capsulitis. A retrospective chart review was performed of all of these patients. A total of 67 patients (69 shoulders) met the inclusion criteria of primary adhesive capsulitis. The patients' range of motion and signs of impingement were documented. The supraspinatus outlet radiographs were assessed, and each patient's acromial morphology was graded as type I, II, or III. A case control group of 53 patients (58 shoulders) was assessed to determine the validity of our results. This group consisted of a series of new patients that were referred to the clinic during February 2003 for assessment of their shoulders. RESULTS: The average age of the patients in the adhesive capsulitis group was 52.5 +/- 7.6 years, with 34 women (50.7%) and 33 men (49.3%). The control group had an average age of 51.1 +/- 16.9 years in a series of 19 (35.8%) women and 34 (64.2%) men. The average range of motion was 98.0 degrees +/- 23.5 degrees of forward elevation, and 91.9 degrees +/- 24.3 degrees of abduction. The forward elevation was 165.5 degrees +/- 15.3 degrees and the abduction was 162.4 degrees +/- 18.4 degrees. The predominant acromial morphology in both groups in this study was a type II acromion (75.4% in the adhesive capsulitis group and 74.1% in the control group). The chi-square analysis within the specific groups showed statistically significant differences in the number of type II compared with type I acromions, and type II compared with type III acromions in both series. However, statistical analysis showed no significant difference between the various acromial types when comparing the adhesive capsulitis group with the control group. CONCLUSIONS: Our results show a significant number of patients with both adhesive capsulitis and, in the control group, type II acromions. We found no statistical difference between these 2 groups. Based on our results, the intrinsic trauma that occurs from subacromial space narrowing caused by the anterior acromial shape, cannot be implicated as the cause of primary adhesive capsulitis. LEVEL OF EVIDENCE: Level III, case control study.

Acromion↗

PubMed1987

Critical evaluation of a pressure-sensitive capsule for measurement of esophageal varix pressure. Studies in vitro and in canine mesenteric vessels.

The accuracy and reliability of a noninvasive pressure-sensitive capsule for the endoscopic measurement of esophageal varix pressure was evaluated. Capsule pressure was correlated with direct intraluminal pressure measurements. The influence of vessel wall tension on capsule pressure was also assessed. In vitro studies demonstrated an excellent correlation (r greater than or equal to 0.94; p less than 0.001) between the pressure obtained with the capsule and intraluminal pressure over a range of vessel diameters and wall thicknesses. In vivo correlation of pressures obtained with the capsule with direct venous pressure measurements was excellent (r = 0.85). However, this correlation decreased with a decrease in vessel diameter (group 1 diameter greater than or equal to 10 mm, r = 0.95; group 2 diameter greater than or equal to 5 mm but less than 10 mm, r = 0.75; group 3 diameter greater than or equal to 3 mm but less than 5 mm, r = 0.81). This decrease in accuracy was significant (p less than 0.001) between group 1 and groups 2 and 3. In vitro and in vivo, capsule pressure variability was significantly greater (p less than 0.001) in vessels of smaller diameter. Wall tension significantly influenced capsule pressure (p less than 0.05), although this effect was only seen in large "vessels" with a diameter beyond a clinically relevant range. Therefore, despite obtaining technically acceptable capsule pressure measurements in ideal experimental conditions, the accuracy and variability of these measurements are limited by vessel size.

Animals↗

PubMed2004

Second capsule endoscopy for patients with severe iron deficiency anemia.

BACKGROUND: Patients with iron deficiency anemia are subjected to multiple endoscopic and radiologic examinations of the GI tract. If negative, some of the examinations are repeated, occasionally with positive findings. The diagnostic yield of a second capsule endoscopy in such patients is unknown. The aim of the current study was to assess the diagnostic yield of a second capsule endoscopy in patients with significant iron deficiency anemia and a previous negative evaluation. METHODS: Twenty patients with iron deficiency anemia (Hb < 10 g/dL) were enrolled. All had at least one normal evaluation of the GI tract, including capsule endoscopy. A second capsule endoscopy examination was offered to all patients. RESULTS: The time between the first and the second capsule endoscopy ranged from 2 months to 1 year. Depending on the nature of an abnormality and its relevance to blood loss, the findings were classified as positive, suspicious, clinically irrelevant, or negative. In 7 patients, the second capsule endoscopy disclosed findings that were classified as either positive or suspicious findings, including arteriovenous malformations (2), flat polypoid lesion (1), edematous inflamed mucosa (1), erosions (1), and hemorrhagic gastritis (1). Lesions were located in the small intestine (5), the stomach (1), and the cecum (1). Based on the findings of the second capsule endoscopy, therapy was changed in two patients (10%). CONCLUSIONS: A second capsule endoscopy should be considered for patients with severe iron deficiency anemia and negative initial evaluation.

Adult↗

PubMed1996

The structure of sensory nerve endings in the knee joint capsule of the dog.

The ultrastructure and distribution patterns of sensory nerve endings in the dorsal knee joint capsules of the beagle dog (Canis familiaris) have been investigated using light and electron microscopy. Each dorsal knee joint capsule was divided into four quadrants, cut into small pieces and then processed for electron microscopy. Free nerve endings and corpuscular nerve endings (Ruffini and lamellated corpuscles) were found. They were most frequently observed in the medial-proximal quadrant of the dorsal joint capsule. All nerve endings were found to be situated within or adjacent to the fibrous layer of the capsule. No nerve endings were found within the synovial layer. Free nerve endings were usually situated at the border between the fibrous layer and the synovial layer near blood vessels. Their associated afferent axon was myelinated (1.5-2.5 microns in diameter) or non-myelinated (0.3-1.5 microns in diameter). Ruffini corpuscles were found in the fibrous layer and within the dorsal ligamentous apparatus. Each Ruffini corpuscle was surrounded by a multilayered perineural capsule which was usually incompletely developed. The perineural capsule is the continuation of the perineurium of the afferent axon and gives a cylindrical form to the corpuscles. Ruffini corpuscles were present as single, cylindrical structures (small corpuscles) or as aggregates of these cylinders (large corpuscles). Both varieties consist of terminal nerve endings surrounded by collagen fibres which pass through the opened ends of the cylinders. The diameter and length of the small Ruffini corpuscles were 80 microns and 400 microns, as compared to 200 microns and 800 microns for the large aggregated forms. The supplying afferent axons of both types were 4-5 microns in diameter. Two types of small lamellated corpuscles could be observed in the fibrous layer: very small corpuscles, 55 microns long, 25 microns wide and medium corpuscles, 100 microns long, 40 microns wide. Each consists of an inner core of terminal Schwann cells, a nerve terminal and a perineural capsule. Some lamellated corpuscles had two inner cores and two nerve terminals. The diameter of the afferent axon was approximately 6 microns. Vater-Pacini corpuscles were not found in the dorsal knee joint capsule of the dog.

Animals↗

PubMed1998

Use of the InteliSite capsule to study ranitidine absorption from various sites within the human intestinal tract.

PURPOSE: The purpose of this study was to evaluate the extent of ranitidine absorption from an externally activated drug-delivery system in two distinct regions of the intestine (jejunum and ileum) in healthy human volunteers. This investigation also was designed to evaluate the utility of the InteliSite capsule for studying regional intestinal drug absorption in humans. METHODS: The intestinal absorption of ranitidine from the jejunum and ileum was compared in eight, healthy volunteers in this open-label, two-way crossover study. In two of the eight volunteers, absorption from the colon also was studied. Subjects swallowed the capsule containing ranitidine solution (121 mg) and 100 microCi of 99mTc-DTPA. The endcap of the capsule contained 20 microCi of (111)In-DTPA. At the desired intestinal site, the capsule was activated by the application of an external RF magnetic signal (6.78 MHz operating frequency) and the ranitidine solution was released. Blood samples were collected from a forearm vein for 12 hours after capsule activation. RESULTS: The capsule released the ranitidine solution when activated in the jejunum, ileum and colon (visualized by the gamma camera). There was no difference in the extent of ranitidine absorption or ranitidine pharmacokinetics when the capsule was activated in the jejunum or ileum. CONCLUSIONS: This study demonstrates the utility of a novel, externally activated drug-delivery system to assess site-specific intestinal drug absorption in humans. Results indicate that use of the InteliSite capsule method to evaluate site-specific intestinal ranitidine absorption in humans yields data similar to that obtained previously by means of oral intubation studies.

Adult↗

PubMed1971

The diffusion capsule, a novel device for the addition of a solute at a constant rate to a liquid medium. Its application to metabolic regulation.

The diffusion capsule consists of a cylindrical container that can be completely filled with a solution and sealed with a small semi-permeable membrane at one end. In use, the capsule is immersed in an agitated liquid. Experiments on concentrated solutions in the capsule showed that, contrary to diffusion theory, the rate of diffusion of solute (sugars or amino acids) out of the capsule remained virtually constant until about 65% of the solute had diffused out of the capsule. Thus the device has been used to maintain constant material feed rates for periods exceeding 30h. The capsule is a simple and compact substitute for a pump and is superior to a pump for small feed rates in many applications. The capsule greatly extends the scope of the shake-flask culture technique for micro-organisms in that substrate-limited growth, possibly the aspect of greatest interest, is readily achieved simply by dropping in the flask a capsule containing the substrate. Diffusion feed should facilitate study of the metabolism of toxic substrates: also it is likely to provide an improved means for supplying a pulse of tracer to a culture.

Amino Acids↗

PubMed2003

Review article: The advent of capsule endoscopy--a not-so-futuristic approach to obscure gastrointestinal bleeding.

Capsule endoscopy is a new, wireless, endoscopic examination of the small intestine. To date, two small clinical trials have been reported utilizing capsule endoscopy in patients with obscure gastrointestinal bleeding, and have shown its superiority to push enteroscopy in diagnosing the cause of blood loss. No outcome studies have been reported. This paper proposes a change in practice guidelines for obscure bleeding. It is our opinion that, in the future, with the advent of wireless capsule endoscopy, the evaluation of patients with obscure gastrointestinal bleeding will be very different from the practice of medicine today. We believe that capsule endoscopy will become the first-line method for the evaluation of patients with obscure bleeding, once upper endoscopy and colonoscopy have been shown to be negative. In patients with active bleeding, capsule endoscopy will confirm the small bowel as the site of bleeding, providing a location, or, if the study is negative for the small intestine, may indicate that the bleeding is either colonic or gastric in origin. In a patient with active bleeding within the small intestine, the capsule will guide further evaluation and therapy. A patient with a small bowel tumour detected by capsule endoscopy will proceed directly to laparoscopic surgery. If the site of bleeding is identified in the proximal small bowel and there is no mass, push enteroscopy will be used to re-identify the site and cauterize it. A distal small bowel site will require surgical intervention, coupled with intra-operative enteroscopy. Should the patient be too sick to undergo surgery, medical therapy utilizing hormonal agents will be considered. A colonic site will be evaluated by colonoscopy. In patients with a more occult or intermittent type of bleeding and in those whose upper endoscopies and colonoscopies are negative, capsule endoscopy will be used similarly to identify a bleeding lesion and thereby direct subsequent testing or treatment.

Endoscopes, Gastrointestinal↗

PubMed1999

The capsule of bacillus anthracis, a review

The capsule of Bacillus anthracis, composed of poly-D-glutamic acid, serves as one of the principal virulence factors during anthrax infection. By virtue of its negative charge, the capsule is purported to inhibit host defence through inhibition of phagocytosis of the vegetative cells by macrophages. In conjunction with lethal toxin and oedema toxin, whose target cells include macrophages and neutrophils, respectively, the capsule allows virulent anthrax bacilli to grow virtually unimpeded in the infected host. Spores germinating in the presence of serum and elevated CO2 release capsule through openings on the spore surface in the form of blebs which may coalesce before sloughing of the exosporium and outgrowth of the fully encapsulated vegetative cell. It has not been established that spore encapsulation plays a role in the early events of anthrax infection. The capsule appears exterior to the S-layer of the vegetative cell and does not require the S-layer for its attachment to the cell surface. The three membrane-associated enzymes required for synthesis of the capsule are encoded by the 60-MDa pX02 plasmid. The cistrons are arranged in the order capB, capC and capA and encode for proteins of 44, 16 and 46 kDa, respectively. The synthesis of capsule and toxin is, in part, under bicarbonate regulation by interaction of transacting proteins of the atxA gene on the 100-MDa pX01 toxin-encoding plasmid and the acpA gene on the pX02 plasmid. Therefore, capsule synthesis is enhanced in the presence of the atxA gene on the pX01 plasmid. An additional protein (with a predicted size of 51 kDa) is encoded by the dep gene located downstream from the cap region and appears to be a depolymerase that catalyses the hydrolysis of poly-D-glutamic acid into lower molecular weight polyglutamates. Although the biological function of the Dep protein is unknown, it has been proposed that the low molecular weight polyglutamates produced by the action of the enzyme may act to inhibit host defence mechanisms.

Journal Article↗

PubMed2001

Spatial and temporal sequence of capsule construction in Cryptococcus neoformans.

The pathogenic yeast Cryptococcus neoformans is distinguished by an extensive polysaccharide capsule, which impedes host defences and is absolutely required for fungal virulence. Despite the biological importance of the capsule, nothing is known about how it is assembled. Substantial capsule growth occurs in two distinct situations relevant to cryptococcal pathogenesis: formation of new buds and induction of capsule on mature cells. We developed pulse-chase protocols to examine these events in a dynamic way using a variety of microscopy techniques. We show that the capsule overlying buds is newly synthesized and differs physically from the corresponding parental material. New capsule formed by mature cells upon induction of synthesis is added at the inner aspect of the existing structure, displacing pre-existing material outwards. Surprisingly, new polysaccharide material is also deposited throughout the capsule, yielding a progressively denser structure. These results yield the first model of capsule synthesis and open new lines of investigation into the underlying mechanisms.

Cell Wall↗

PubMed2005

Comparison of capsule endoscopy with ileocolonoscopy for detecting small-bowel lesions in patients with seronegative spondyloarthropathies.

BACKGROUND AND STUDY AIMS: Patients with spondyloarthropathies are often found to have signs of small-bowel inflammation when examined by ileocolonoscopy. Because capsule endoscopy has been found to be superior to other endoscopic and radiological modalities in the detection of small-bowel inflammation, we aimed to compare the diagnostic yield of capsule endoscopy with that of ileocolonoscopy in the detection of small-bowel lesions in patients with spondyloarthropathies. PATIENTS AND METHODS: Twenty patients with documented seronegative peripheral arthritis, ankylosing spondylitis, or sacroiliitis, who had not taken nonsteroidal anti-inflammatory drugs (NSAIDs) in the preceding 2 months, participated in the study. The patients underwent capsule endoscopy, followed by ileocolonoscopy within 7 days, with blinded assessment of both examinations. Biopsies were taken when indicated and adverse events were monitored. Patients completed a questionnaire on their satisfaction with the two procedures. RESULTS: A total of 20 patients (11 men, 9 women; mean age 41+/-13 years) with seronegative inflammatory spondyloarthropathies but without abdominal complaints completed the study. No adverse effects were reported and all the capsules were excreted. Of these 20 patients, 11 (55%) had a normal small bowel on both examinations. Significant small-bowel findings (erythema, mucosal breaks, aphthous or linear ulcers, erosions) were detected by capsule endoscopy in six patients (30%) and by ileocolonoscopy in only one patient. In addition, capsule endoscopy detected significant upper gastrointestinal pathology in 40% of patients. The patients preferred capsule endoscopy to ileocolonoscopy. CONCLUSIONS: Capsule endoscopy detected more small-bowel lesions than ileocolonoscopy, and provided additional potentially relevant information on upper gastrointestinal pathology in patients with spondyloarthropathies.

Adult↗

PubMed2002

Organization of the interior of molecular capsules by hydrogen bonding.

The enclosure of functional entities within a protective boundary is an essential feature of biological systems. On a molecular scale, free-standing capsules with an internal volume sufficiently large to house molecular species have been synthesized and studied for more than a decade. These capsules have been prepared by either covalent synthesis or self-assembly, and the internal volumes have ranged from 200 to 1,500 A(3). Although biological systems possess a remarkable degree of order within the protective boundaries, to date only steric constraints have been used to order the guests within molecular capsules. In this article we describe the synthesis and characterization of hexameric molecular capsules held together by hydrogen bonding. These capsules possess internal order of the guests brought about by hydrogen bond donors within, but not used by, the framework of the capsule. The basic building blocks of the hexameric capsules are tetrameric macrocycles related to resorcin[4]arenes and pyrogallol[4]arenes. The former contain four 1,3-dihydroxybenzene rings bridged together by -CHR- units, whereas the latter contain four 1,2,3-trihydroxybenzene rings bridged together. We now report the synthesis of related mixed macrocycles, and the main focus is on the macrocycle composed of three 1,2,3-trihydroxybenzene rings and one 1,3-dihydroxybenzene ring bridged together. The mixed macrocycles self-assemble from a mixture of closely related compounds to form the hexameric capsule with internally ordered guests.

Benzene↗

PubMed2006

Colon-specific delivery and enhanced colonic absorption of [Asu(1,7)]-eel calcitonin using chitosan capsules containing various additives in rats.

The objective of this study was to estimate the colon-specific delivery of [Asu1,7]-eel calcitonin (ECT) using chitosan capsules in rats. The intestinal absorption of ECT was evaluated by measuring the plasma calcium levels after oral administration of the chitosan capsules containing ECT and different combinations of additives. The same combinations were investigated by an in situ absorption experiment prior to in vivo administration of capsules. A marked decrease in plasma calcium levels was observed following the oral administration of chitosan capsules containing ECT, S-nitroso-N-acetyl-dl-penicillamine (SNAP), sodium glycocholate, bacitracin and aprotinin (pharmacological availability (PA)% = 6.344%), as compared with capsules containing only ECT (PA% = 0.551%) or capsules containing ECT with SNAP only (PA% = 1.651%). The hypocalcemic effect started 6-8 h after oral administration of capsules and sustained for 24 h. These findings suggest that colon-specific delivery of ECT can be achieved using chitosan capsules and these additives may be useful for improving the colonic absorption of ECT in rats.

Animals↗

PubMed1978

Experimental effects on surrounding fibrous capsule formation from placing steroid in a silicone bag-gel prosthesis before implantation.

Soft-gel miniprostheses of silicone were implanted subcutaneously into 75 male rats. Groups of prostheses were preinjected with saline, a commercial form of triamcinolone acetonide, or a suspension of crystalline triamcinolone acetonide. The softness of the prosthesis mound later was measured objectively, and the capsules surrounding the implants were analyzed by histology, SEM, and chemistry, at various intervals up to 120 days after implantation. The control implants developed a normal laminar capsule. With an incidence increasing up to 100 percent at 120 days, the steroid-treated implants were surrounded by capsules lacking an inner membrane. The inner membrane of the laminar capsule had a high protein content (relative to normal tissue) and a relatively reduced collagen content, while the diffuse capsule resulting from the TA treatment had a high protein content and a high collagen content (about the same as normal tissue). No differences were found in the softness of the mounds of the implanted prostheses. The effect of the TA treatment was explained on the basis of its collagenolytic effect, which could gradually erode the normal capsule membrane. Capsule firmness could not be related to the architecture or the protein or collagen content in our findings. We hypothesize that normal capsule firmness may be related to the amount and kind of interconnection between the loose outer zone of connective tissue and the surrounding tissue.

Animals↗

PubMed1993

Peptide growth factors and myofibroblasts in capsules around human breast implants.

Peptide growth factors were mapped immunohistochemically for assessment of their presumed relation to the cells in capsules enveloping gel-filled, smooth-surfaced silicone mammary implants (12 capsules from 11 women). The implant capsules were dominated by fibroblast-like cells, but there were as well macrophages, inflammatory cells, and vascular cells. These cells expressed immunoreactivity for TGF-beta, IGF-II, IGF-I, and, to a lesser extent, PDGFB, NGF, and TNF-alpha. The numerous spindle-shaped cells in the contracted capsules displayed several distinct cytoplasmic actin bundles and fulfilled ultrastructural criteria for myofibroblasts. In contrast, myofibroblasts were recognized in low frequencies in the noncontracted capsules. Mature skin scar tissue did not show any peptide growth factor immunoreactivity, and myofibroblasts were absent. It is postulated that the low-grade chronic inflammatory foreign-body reaction, aggravated by mechanical stress and possible leakage of irritants, stimulates capsule cells to form peptide growth factors, reflecting that extended healing processes prevail in both noncontracted and contracted capsules. We propose that the local enrichment of peptide growth factors, beneficial for acute wound healing, in the chronically irritated tissue around implants provides trophic support for the contractile cells in the implant capsules.

Biopsy↗

PubMed1994

The capsule quality of saline-filled smooth silicone, textured silicone, and polyurethane implants in rabbits: a long-term study.

Recently, there have been many new designs in both the surface texture and chemical composition of breast implants that claim reduced constrictive capsular formation. The purpose of this study was to utilize a quantitative method to determine the firmness of capsules formed around saline-filled smooth silicone, textured silicone, and polyurethane implants in an experimental rabbit model 1 year after implantation. Our objective was to analyze the histologic, biologic, and biochemical content of the respective capsules to account for any differences in physical behavior. Forty-five smooth silicone, textured silicone, and polyurethane implants were placed in one of three positions beneath the panniculus carnosus muscle of New Zealand White rabbits. After 1 year, all capsules were palpated and classified according to firmness. Intracapsular static and dynamic pressure measurements were obtained by placing a pressure monitor (Stryker) in an injector port attached to the individual implants. Capsular firmness was significantly greater in the textured silicone implants than in the smooth silicone or polyurethane implants after 1 year. The dynamic qualities of the periprosthetic soft tissues were measured while saline was injected into the implants. The capsules around the textured silicone implants generated significantly higher pressures than the smooth silicone or polyurethane counterparts. The capsules around the polyurethane implants were the softest and most compliant in all categories. Histologically, there is a significant inflammatory response surrounding the textured silicone implants that does not exist in the capsules around the smooth silicone implants. The capsules around the polyurethane implants have the least fibrous tissue deposition. There is a decrease in the proportion of type III collagen in the capsules around the textured silicone implants versus smooth silicone or polyurethane implants. The in vitro contraction patterns of the fibroblast-populated collagen lattices do not reveal the contraction differences observed in vivo in rabbits. However, there are many components that determine contractility. This area deserves further investigation.

Animals↗

PubMed2004

Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel.

OBJECTIVE: The Given Capsule procedure is a new system designed to aid the gastroenterologist in diagnosing small-bowel disease. Capsule endoscopy has provided gastroenterologists with easy access to small-bowel mucosa for examination by direct visualisation. The aim of our prospective study was to determine the indication for capsule endoscopy and to describe the identified pathology within the gastrointestinal tract. METHODS: Patients with unexplained gastrointestinal bleeding from suspected small-bowel pathology of an undisclosed nature or with unexplained abdominal pain for more than 6 months were eligible to undergo capsule endoscopy. Patients with suspected intestinal obstruction or with a history of major abdominal surgery were excluded. RESULTS: One hundred and sixty patients (70 women, 90 men; mean age 49.0 +/- 19.8 years, range 13-91 years) ingested the capsule easily. They had undergone 6 +/- 2.9 investigative procedures before capsule endoscopy. Two (1.25%) patients who had non-natural excretions underwent surgery: one was found to have Meckel's diverticulum and the other had stricturing Crohn's disease. The mean haemoglobin in iron-deficiency anaemia patients was 9.1 +/- 2.2 g%. The diagnostic yield of capsule endoscopy was 57.7% in iron-deficiency anaemia and 52.4% in suspected Crohn's disease. CONCLUSIONS: Capsule endoscopy detected the more clinically significant intestinal lesions. It was of diagnostic value in patients with obscure bleeding, suspected Crohn's disease and malabsorption, but the diagnostic yield in patients with chronic pain or irritable bowel syndrome-type symptoms was low.

Adolescent↗