SEARCH · PubMed Health

Results for “Sigmoidoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources

PubMed1992

Perceived core procedural skills for Nebraska family physicians.

We conducted a mail survey of 287 practicing family physicians, 22 family practice faculty, and 60 family practice residents in both rural and urban Nebraska concerning their perceptions of "core" procedures in family medicine and their perceived competency in performing them. Final response rate was 45%. There was general agreement concerning what constituted the core procedures in family medicine, although several newer procedures, such as flexible sigmoidoscopy, provoked more controversy. Rural physicians were more likely to classify intrauterine device insertion, endometrial biopsy, and cervical biopsy as core procedures than their urban counterparts. As expected, whether a physician performed a procedure related directly to his reported competence in performing it. However, there were discrepancies between perceived training during residency and current practice for control of nasal hemorrhage, aspiration of breast mass, flexible sigmoidoscopy, endometrial biopsy, and joint aspiration. Faculty programs for teaching procedural skills, standards for documenting competence, and systems for ongoing quality assurance should be further developed.

Clinical Competence↗

PubMed2003

State-specific prevalence of selected chronic disease-related characteristics--Behavioral Risk Factor Surveillance System, 2001.

PROBLEM: High-risk behaviors and lack of preventive care are associated with higher rates of morbidity and mortality in the United States. Without continued monitoring of these factors, state health departments would have difficulty tracking and evaluating progress toward Healthy People 2010 and their own state objectives. Monitoring chronic disease-related behaviors is also key to developing targeted education and intervention programs at the national, state, and local levels to improve the health of the public. REPORTING PERIOD COVERED: Data collected in 2001 are compared with data from 1991 and 2000, and progress toward Healthy People 2010 targets is assessed. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, telephone survey of persons aged > or =18 years. State health departments collect the data in collaboration with CDC. In 2001, participants in data collection included all 50 states, the District of Columbia, Guam, the U.S. Virgin Islands, and the Commonwealth of Puerto Rico. BRFSS data are used to track the prevalence of chronic disease-related characteristics and monitor progress toward national health objectives related to 1) decreasing high-risk behaviors, 2) increasing awareness of medical conditions, and 3) increasing use of preventive health services. For certain national objectives, BRFSS is the only source of data. RESULTS: BRFSS data indicate changes in certain high-risk behaviors from 1991 to 2001. Among the findings are substantial increases in the prevalence of obesity among adults aged > or =20 years. Among states, prevalence of persons classified as obese in 2001 ranged from 15.5% in Colorado to 27.1% in Mississippi. From 1991 to 2001, the median prevalence for all participating states and territories increased from 12.9% to 21.6%. In 1991, no state had an obesity prevalence of > or =20%; in 2001, 37 states had a prevalence of > or =20%. Percentage increases in prevalence of obesity, from 1991 to 2001, ranged from 24.9% in the District of Columbia to 140.2% in New Mexico. In 2001, substantial variations also existed among states and territories regarding prevalence of other high-risk behaviors and awareness of medical conditions. Ranges included, for no leisure-time physical activity, 16.5% (Utah) to 49.2% (Puerto Rico); cigarette smoking, 9.6% (Virgin Islands) to 31.2% (Guam); binge drinking, 6.8% (Tennessee) to 25.7% (Wisconsin); heavy drinking, 2.5% (Tennessee) to 8.7% (Wisconsin); persons ever told they had diabetes, 4% (Alaska) to 9.8% (Puerto Rico); persons ever told they had high blood pressure, 20% (New Mexico) to 32.5% (West Virginia); and persons ever told they had high blood cholesterol, 24.8% (New Mexico) to 37.7% (West Virginia). Substantial variations also existed among states regarding prevalence of using preventive health services. Ranges included, for persons aged > or =50 years ever screened for colorectal cancer by use of sigmoidoscopy or colonoscopy, 30.5% (Virgin Islands) to 62% (Minnesota); persons aged > or =65 years who received an influenza vaccination in the past year, 36.8% (Puerto Rico) to 79% (Hawaii); persons aged > or =65 years who ever received a pneumococcal vaccination, 24.1% (Puerto Rico) to 70.9% (Oregon). In 2001, 13 states, Guam, and the U.S. Virgin Islands used the women's health module. Ranges included, for women aged > or =18 years who had a Papanicolaou (Pap) smear test in the past 3 years, 79.8% (Virgin Islands) to 89.6% (Wisconsin); women aged > or =40 years who ever had a mammogram, 71.9% (Virgin Islands) to 93% (Rhode Island); and women aged > or =40 years who had a mammogram in the past 2 years, 57.2% (Virgin Islands) to 85.1% (Rhode Island). BRFSS data in 2001 also indicated variations by sex, race or ethnicity, and age group. Greater percentages of men than women reported cigarette smoking, binge drinking, heavy drinking, and were classified as overweight; greater percentages of women reported no leisure-time physical activity. Among racial or ethnic groups, greater percentages of black non-Hispanics than other groups reported being told by a health professional they had high blood pressure and diabetes, and were classified as obese; greater percentages of white non-Hispanics than other groups reported being told they had high cholesterol. Among age groups, greater percentages of persons aged 18-24 years than those in older groups reported smoking cigarettes, binge drinking and heavy drinking; greater percentages of persons in older age groups than younger age groups reported being told they had diabetes, high blood pressure, and high blood cholesterol. Also, comparison of 2001 BRFSS data with 12 targets from Healthy People 2010 indicates that, in 2001, no state had met the targets for obesity, cigarette smoking, binge drinking, receiving a fecal occult blood test within the past 2 years, receiving annual influenza vaccinations, receiving pneumococcal vaccinations, and receiving Pap tests. Certain states had already met targets for no leisure-time activity, receiving a sigmoidoscopy or colonoscopy, having blood cholesterol checked within the past 5 years, and receiving a mammogram within the past 2 years. INTERPRETATION: BRFSS data in this report indicate that despite certain improvements, persons in a high proportion of U.S. states and territories continue to engage in high-risk behaviors and do not report making sufficient use of preventive health practices. Substantial variations (i.e., by state, sex, age group, and race/ethnicity) in prevalence of behaviors, awareness of medical conditions, and use of preventive services indicate a continued need to monitor these factors at state and local levels and assess progress toward reducing morbidity and mortality. PUBLIC HEALTH ACTIONS: BRFSS data can be used to guide public health actions at local, state, and national levels. For certain states, BRFSS is the only reliable source of chronic-disease-related, risk-behavioral data. BRFSS data enable states to design, implement, evaluate, and monitor health-promotion strategies, targeting specific high-risk behaviors among populations experiencing high burdens of disease. BRFSS data continue to be key sources for assessing progress toward both national Healthy People 2010 objectives and state health objectives.

Adult↗

PubMed1992

[Early diagnosis saves human lives--on the status of colorectal tumors].

UNLABELLED: Colorectal cancers are on rang 3 of the malignant tumors in men and in women in incidence as well as in mortality. The only method to save more patients with these tumors is the early detection. It is to realize at its best by combination of digital rectal examination (DRE), testing for blood in feces and sigmoidoscopy. About DRE nothing is to discuss. The lack of a method without a high percentage of false negative and false positive results is the main problem of testing blood in feces. But the existing methods have to be used until more effective ones will be developed. Method no 3 is the sigmoidoscopy with the new generation of flexible instruments. Doctors have to prefer them because their use is easier, more informative and better tolerable for patients as the old rigid rectoscops. An additional method to evaluate the tumor expansion during surgical treatment is the endoscopic ultrasound examination. It enables the surgeon to look through the colorectal wall for evaluation of the tumor-spreading. There is no doubt, that the surgical treatment is the most effective. It can save around 90% of tumor patients if the tumor is detected in an early stage. The results of chemotherapy are not convincing at all. 5-fluorouracil (5-FU) seems to be the most effective but not curing drug, possibly in combination with immunemodulators. IN CONCLUSION: Colorectal cancer, early detection is the key. If the patient, the practicien and the surgeon will have this in mind, 50,000 pats with colorectal cancer more could be saved this year in the USA. Similar results should be possible in our country also.

Colorectal Neoplasms↗

PubMed2006

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.

Behavioral Risk Factor Surveillance System↗

PubMed2006

Rates and predictors of colorectal cancer screening.

INTRODUCTION: Despite widespread recommendations for colorectal cancer screening, the U.S. screening rate is low. The objectives of this study were to describe the rates and predictors of colorectal cancer screening use by examining groups in two categories--1) those who have ever been screened and 2) those with up-to-date screening--and to assess whether trends and predictors change over time. METHODS: We analyzed data from the 2000 and 2003 National Health Interview Surveys about the use of fecal occult blood tests, sigmoidoscopies, and colonoscopies for adults aged 50 years and older and without a history of colorectal cancer (N = 11,574 in 2000 and N = 11,779 in 2003). RESULTS: Rates in the 2000 study population of those who have ever been screened for colorectal cancer (53%) had increased in the 2003 study population (55%) as had the rates in the 2003 study population of those with up-to-date colorectal screening (53%) compared with the rates in the 2000 study population (38%). Among those who were ever screened, 76% were up-to-date with screening in 2003, compared with 68% in 2000. There was increased use of colonoscopies but decreased use of fecal occult blood tests and sigmoidoscopies. Individuals were more likely to be up-to-date with screening if they had higher income, higher education, insurance coverage, a usual source of care, and a dental visit in the last year than if these predictors were not evident. Since 2000, these predictors of colorectal cancer screening use have remained stable. CONCLUSION: Although there has been relatively limited success in increasing overall screening, it is encouraging that most people in the group of those who have ever been screened are up-to-date with colorectal cancer screening. Predictors for colorectal screening were stable over time despite changes in screening policies and rates. Further research is needed to uncover barriers to colorectal cancer screening.

Adult↗

PubMed1991

Investigation of rectal bleeding.

We studied a consecutive series of 115 patients presenting to one gastroenterologist with non-emergency rectal bleeding or positive faecal occult blood studies. When there is a clear history that the bleeding was perianal, 26 out of 33 patients (79%) were found to have haemorrhoids. In the absence of such a history (n = 82), 16 patients (20%) had colonic cancer or polyps, 20 (25%) colitis; 24 (29%) perianal disease while only 15 (18%) had no pathology demonstrated. Our experience coupled with a review of the literature on the investigation of rectal bleeding lead us to the following recommendations: (1) Total colonoscopy or flexible sigmoidoscopy plus double contrast barium enema should normally be performed; (2) when there is a clear history that the bleeding is perianal, flexible sigmoidoscopy may suffice.

Adolescent↗

PubMed1991

Barium enema use in Indiana.

All 118 hospital-based radiology departments in Indiana responded to a survey of barium enema (BE) use. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE) for various indications, was similar to that reported for major medical centers around the world. The use of SCBE and DCBE did not differ between small and large hospitals or between hospitals in small versus large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema usually was performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Like major medical centers, there is no consensus regarding many issues in the performance of BE.

Barium Sulfate↗

PubMed1989

Ischemic colitis following abdominal aortic reconstruction for ruptured aneurysm. A 10-year experience.

Between January 1, 1978, and December 31, 1987, a total of 103 patients had operations for ruptured abdominal aortic aneurysms. The average age was 73 years (range, 53 to 91 years). Thirty-two patients died during surgery or in the immediate postoperative period. In 19 of the remaining 71 patients ischemic colitis developed, an incidence of 27 per cent. This report reviews the clinical findings and course of these patients. The average age of patients developing ischemic colitis was 72 years (range, 53 to 90 years), not significantly different from the group as a whole. There was no correlation between the type of vascular reconstruction and the development of ischemic colitis. Eleven patients died and eight survived, for a mortality rate of 58 per cent. The most common clinical finding was diarrhea early in the postoperative period, which was noted in 20 patients. Thirteen of these patients had ischemic colitis confirmed by flexible sigmoidoscopy. Eight (62%) of these 13 patients survived; three were managed nonoperatively and five had colectomy. Six patients presented between postoperative days 9 and 20 with signs of increasing sepsis but with no diarrhea or other significant clinical findings; ischemic colitis was confirmed by sigmoidoscopy in all six patients. All of these patients died of septic complications. Seven patients with early postoperative diarrhea had normal sigmoidoscopic findings. None developed septic complications and five survived; two died of cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

Death from unsuspected colorectal cancer.

An analysis of all subjects undergoing autopsy in the Plymouth Health District over a 10-year period revealed 61 cases of unsuspected colorectal cancer. The carcinoma was the primary cause of death in 57 cases and surgical treatment for cure might have been possible in over one-half. The 61 subjects accounted for 4.1% of all cases of fatal colorectal cancer in this area. Examination by means of rectal digital palpation, rigid sigmoidoscopy and flexible sigmoidoscopy might have diagnosed 10, 24 and 41 carcinomas respectively. This study has demonstrated that a significant number of colorectal cancers remain undetected until after death. These cases should be included in future studies of colorectal cancer.

Aged↗

PubMed1977

Rectal wall bleeding--an overlooked source of massive lower gastrointestinal hemorrhage.

Two cases of acute massive bleeding from the rectum are described. In both cases, the diagnosis was made angiographically. Some points of angiographic technique are discussed. In both cases, there had been previous negative sigmoidoscopy. Care must be taken to include the entire rectum on the films obtained during injection of the inferior mesenteric artery regardless of findings on sigmoidoscopy.

Adult↗

PubMed1988

Colonoscopy in the diagnosis and management of colorectal neoplasia in a DGH.

Patients presenting to a district general hospital (DGH) with colorectal neoplasms have been studied before and after the introduction of a colonoscopy service, in order to investigate the diagnostic, therapeutic and economic benefits of performing colonoscopy in preference to sigmoidoscopy and double contrast barium enema (DCBE). Colonoscopy led to a 3-fold increase in the incidence of colonic polyps, and 22% of all adenomas showed worrying features. Severe dysplasia and malignancy was seen most frequently in large adenomas (greater than 2 cm), and in those with a villous component. Laparotomy was avoided in 31 patients with proximal polyps, giving colonoscopy an added therapeutic and economic advantage over sigmoidoscopy and DCBE. Colonoscopy was used less frequently to detect colonic carcinomas, as over half of these were rectal, or presented as emergencies. These findings confirm the value of performing colonoscopy in patients who present with colorectal symptoms.

Adenoma↗

PubMed1987

Diagnostic and therapeutic aspects of rectal trauma. Blunt versus penetrating.

In the last 6 years, nine patients with blunt and 16 with penetrating rectal injuries were treated at University Hospital, Jacksonville, Florida. Blunt trauma was caused by vehicular accidents in seven patients and crush injuries in two. Penetrating rectal trauma was due to gunshot wounds in ten patients and foreign body insertion in six. All patients with blunt injury had bright red rectal bleeding, which led to diagnostic sigmoidoscopy. Rectal injury was identified at sigmoidoscopy in 12 patients who had penetrating wounds and at laparotomy in four patients. Thirteen patients who had penetrating rectal trauma had injury to only the rectum or to one additional organ. In contrast, all patients who had blunt rectal trauma had at least three associated injuries. In the penetrating group, 13 patients were treated by colostomy and mucus fistula; three patients with mucosal injury were managed nonoperatively. The only death occurred in a patient whose rectal injury was initially missed. Patients who had blunt rectal trauma were managed with colostomy and mucus fistula. Three patients died postoperatively, two of pelvic bleeding and one of head injury. Hemodynamic stabilization, colostomy and mucus fistula, presacral drainage, and rectal washout constitute proper treatment of patients with blunt or penetrating rectal trauma. Because of the greater number and severity of associated injuries, morbidity and mortality are higher after blunt rectal trauma.

Accidents, Traffic↗

PubMed1995

[Effectiveness and costs of screening colonoscopy].

Screening colonoscopy is always indicated when rectosigmoidoscopy reveals an adenoma, since this lesion roughly doubles the patient's risk of contracting colonic cancer. Follow-up should be performed at intervals of about three years after endoscopic removal of all colorectal polyps. Repeated screening examinations are recommended for the following genetic diseases that carry an increased risk of colorectal carcinoma: familial adenomatous polyposis (FAP) and its genetic variant, hereditary non-polyposis colorectal cancer syndrome (HNPCC) and hamartomatous polyposis syndromes (e.g. Peutz-Jeghers). Also in the case of familial "sporadic" carcinoma of the colon, regular screening colonoscopies for first degree relatives are recommended. Although the use of regular screening colonoscopies in patients with a long history of extensive ulcerative colitis is controversial, the recent results support such examinations. While the benefit of screening colonoscopy or sigmoidoscopy of the general population from the age of 50 onward must be affirmed, it should be weighed against the costs involved in such an undertaking. At the present time, the American Cancer Society recommends that from the age of 50 onward, the annual fecal test for occult blood should be supplemented by sigmoidoscopy performed every three to five years.

Adenomatous Polyposis Coli↗

PubMed1995

[Screening coloscopy: when and how?].

Screening colonoscopy aims at a reduction of colorectal cancer mortality. The efficacy is undetermined due to lack of controlled trials. However, screening colonoscopy is generally accepted in asymptomatic patient with a considerably increased risk for carcinoma in particular in case of familial adenomatous polyposis coli, hereditary nonpolypous colorectal cancer syndrome and adenomas detected by sigmoidoscopy. A positive cost/benefit ratio can also be expected in first-degree relatives of patients with familial sporadic colorectal carcinoma. To date the efficacy of colonoscopic surveillance of patients with extensive ulcerative colitis remains undetermined in spite of an increased risk of cancer in the long-term course. In people with an average risk for colorectal cancer the probability of a development of carcinoma might be reduced by about 45% by once-only sigmoidoscopy performed at the age of 50-60 years. Further reduction can theoretically be expected from routine colonoscopy. However, before a general recommendation can be given, the efficacy must be proved in a randomised controlled trial.

Adenomatous Polyposis Coli↗

PubMed1995

The outcome of familial adenomatous polyposis in the absence of a polyposis registry.

From 1964 to 1990, 70 patients with familial adenomatous polyposis were diagnosed at an institution without a polyposis registry. Those with symptoms at diagnosis were older (mean 34 v. 24 years) and more often had large-bowel cancer (7/30 v. 1/30, 23% v. 3%). The introduction of systematic screening significantly increased the number of cases diagnosed annually, from 2,3 to 5 per year, reduced the median age at diagnosis from 29 to 21 years and increased the proportion of cases diagnosed without symptoms from 52% to 90%. A colectomy with an ileorectal anastomosis achieved a low incidence of rectal cancer at 20 years (1/15, 7%) despite imperfect follow-up and annual sigmoidoscopy in only 40%. However, bowel cancer caused at least 35% of all deaths and 62% of deaths due to a known cause. A registry which maintained a screening programme should therefore prevent most large-bowel cancers and improve the life expectancy of patients with familial adenomatous polyposis who are managed at this institution. It might also refine the current method of screening by sigmoidoscopy alone, by facilitating the use of ophthalmoscopy and blood tests for DNA markers.

Adenomatous Polyposis Coli↗

PubMedDate not supplied

Endoscopic screening for colorectal cancer: recent studies from Indiana University.

Fecal occult blood testing is inadequate as a sole screening measure for colorectal cancer. Endoscopic screening and adenoma removal is now proven to reduce colorectal cancer mortality. At the Indiana University Colorectal Cancer Screening Center, studies have clarified several issues regarding endoscopic screening for colorectal cancer. Screening colonoscopy in 621 asymptomatic adults aged 50 to 75 years demonstrated that 27% had colonic adenomas. Increasing age and male gender were both powerful predictors of an increased prevalence of colonic adenomas. A family history of a single first-degree relative who developed colorectal cancer at age 60 or older did not predict a higher prevalence of colonic adenomas. All cancers and all adenomas greater than or equal to 1 cm in size found in average-risk persons were found in persons aged 60 or older. Half of the people with adenomas had no neoplasia within reach of the flexible sigmoidoscope. Based on these findings, we have suggested that a single screening colonoscopy performed in average-risk person in their early sixties may be an effective method to reduce colorectal cancer mortality. In the screening colonoscopy study, distal colonic hyperplastic polyps were shown to not predict proximal colon adenomas. Therefore, colonoscopy is not warranted when only hyperplastic polyps are detected by flexible sigmoidoscopy in asymptomatic, average-risk people. Screening sigmoidoscopic exams using colonoscopes showed that 60 cm scopes have the optimal length for flexible sigmoidoscopy in unsedated patients. Finally, a screening colonoscopy study demonstrated that women with a personal history of breast cancer do not have an increased prevalence of colonic adenomas.

Aged↗

PubMed1993

[Endoscopic studies of the digestive tract as a service for family practitioners; experience in the Eindhoven area].

In May 1989 an open access endoscopy service for general practitioners (GPs) was started in the region of Eindhoven. In the four hospitals covering a population of 500,000 inhabitants, served by 200 GPs, uniform working agreements were made. We evaluated the endoscopies performed in 1990 and compared the total number of endoscopies with that of gastrointestinal X-rays. A total of 996 open access gastroscopies were performed. The most important diagnoses were: peptic ulcer (19%), oesophagitis (16%), bulbitis (9%) and carcinoma (1.5%). The diagnostic yield was 57%. A total of 509 GP-referred sigmoidoscopies were performed. The most important diagnoses were: haemorrhoids and anal fissure (28%), colitis (15%), diverticulosis (12%), neoplastic polyps (11%) and carcinoma (4%). The diagnostic yield was 77%. Compared with 1989 the total number of gastroscopies, requested by GPs and by specialists, increased by 15% of which two-thirds were requested by the GPs. In this period the reduction of barium meals was 11% which was almost exclusively due to the specialist group. Sigmoidoscopies increased by 7%, entirely due to the GP group. The number of barium enemas remained constant. Open access endoscopy resulted in an increase endoscopies with only a partial substitution of radiological examinations. The increase in endoscopic examinations in the GP group did not result in a decline in the specialist group. The total diagnostic yield was 64%.

Adolescent↗

PubMed1977

Transient bacteremia and endocarditis prophylaxis. A review.

Transient, usually asymptomatic bacteremia occurs in a wide variety of procedures and manipulations, particularly those associated with mucous membrane trauma. It may also occur with such daily functions as tooth brushing and bowel movements. These brief bacteremias are especially common in tooth extraction and other dental procedures. Although numerical risk is uncertain, these bacteremias can occasionally give rise to infective endocarditis in the susceptible patient. While no proof exists that antibiotics given prior to procedures causing bacteremia prevent endocarditis in humans, experimental evidence in rabbits supports their use. Therefore, in situations where bacteremia is highly predictable, it would seem wise to administer prophylactic antimicrobials. Procedures in the susceptible host where prophylactic antibiotics seem prudent include dental manipulations and urinary tract instrumentation. Whether patients with acquired valvular or congenital heart disease who are to undergo abdominal surgical procedures should routinely receive prophylactic antibiotics is unclear. However, until the incidence of transient bacteremia associated with various abdominal procedures is further defined, endocarditis-prone patients should probably receive prophylaxis. Furthermore, patients with prosthetic valves who are subjected to upper gastrointestinal endoscopy, sigmoidoscopy, liver biopsy, or barium enema should also probably have antibiotic pretreatment. For dental procedures and for upper gastrointestinal endoscopy in patients with prosthetic valves, a combination of penicillin and streptomycin or vancomycin alone is recommended. For urinary tract instrumentation in all patients and for sigmoidoscopy, liver biopsy, or barium enema in patients with prosthetic valves, prophylaxis should be with ampicillin and gentamicin or vancomycin and gentamicin.

Anti-Bacterial Agents↗