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At least 19 recordsLinked to original sources
PubMed2002

Trypsin-based laboratory methods and carboxypeptidase activation peptide in acute pancreatitis.

Acute pancreatitis is a common disease varying widely in severity. At present, there is no "gold standard" for the diagnosis of acute pancreatitis. Currently, the diagnosis of acute pancreatitis is based on measurements of serum amylase and/or lipase activity, which are considered unsatisfactory due to their low level of accuracy. Early identification of acute pancreatitis and especially detection of patients with a severe form of the disease is of utmost importance. Premature intrapancreatic activation of trypsinogen is a crucial early event in the pathophysiology of acute pancreatitis. The conversion of trypsinogen to active trypsin is mediated by the release of its activation peptide (TAP). The active trypsin is then able to activate other pancreatic zymogens (i.e. procarboxypeptidase) leading to tissue damage and eventually to autodigestion of the pancreas. To improve the laboratory diagnostics of AP, new methods have been developed to measure this primary pancreatic proteolytic insult. Here we review the current knowledge and clinical implications of trypsin based laboratory methods and carboxypeptidase activation peptide (CAPAP) in the diagnosis and severity assessment of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

Common laboratory and diagnostic testing in patients with gastrointestinal disease.

Evaluating patients with gastrointestinal (GI) illness involves the use of many different diagnostic modalities, including laboratory studies, diagnostic imaging, and endoscopy. Rapid advances in all three areas have provided clinicians with a wide array of testing at their fingertips. The frequent challenge in evaluating a patient is deciding which testing will lead to a diagnosis in the most direct and efficient manner. This article reviews many of the tests that are considered in the evaluation of individuals with complaints referable to the GI tract.

Angiography↗
PubMed2002

Intestinal permeability and absorptive capacity in children with portal hypertension.

BACKGROUND: Portal hypertension may affect intestinal function leading to malnutrition in children with liver disease. The aim was to determine whether children with portal hypertension with or without liver disease had impaired absorptive capacity and intestinal barrier function (intestinal permeability) and to ascertain whether these abnormalities related to changes in body composition. METHODS: Twenty-six children with portal hypertension were divided according to aetiology into: Group 1 intrahepatic (n = 15) and Group 2 prehepatic (n = 11). Thirty-five children acted as controls. Carbohydrate absorption and intestinal permeability were assessed using a sugar absorption/permeability test and a variety of anthropometric measurements were obtained. RESULTS: 3-O-methyl-D-glucose, D-xylose and L-rhamnose excretion were significantly reduced in both patient groups compared to controls (P < or = 0.008) and the differential urinary excretion of melibiose/rhamnose (intestinal permeability) was significantly increased in Group 1 only (P < 0.05). Anthropometric measurements showed low Z scores in both groups, but there was no significant (P > 0.05) difference between them. There was no significant correlation between urinary excretion of sugars. anthropometric measurements and energy intake. CONCLUSIONS: Increased portal pressure reduces the absorptive capacity of the small intestine, while liver disease itself leads to increased intestinal permeability.

Adolescent↗
PubMed2000

[The digestive system].

Explore the source record for details and available documents.

Diagnostic Techniques, Digestive System↗
PubMed2002

Autonomic nerve dysfunction in pathologically obese patients.

BACKGROUND: Obese patients frequently present clinical symptoms related to gastrointestinal motility alterations and autonomic nervous system dysfunction. AIM: To evaluate the possible correlation between cardiovascular autonomic nervous dysfunction and oesophageal motility in pathologically obese patients. PATIENTS AND METHODS: Enrolled in the study were 22 patients with a body mass index of 45.72 +/- 7.48 and 10 control subjects, all within 20% of their ideal weight. Oesophageal motility was measured by stationary manometry and scintigraphic transit. Tests for the evaluation of autonomic nervous system were: Valsalva ratio, deep breathing, sustained handgrip, sudormotor axon reflex test and spectral analysis of the variability of R-R interval. RESULTS: The mean pressure of oesophageal peristaltic waves in patients and controls was 39.36 +/- 14 mmHg and 73 +/- 12 mmHg, respectively The scintigraphic mean transit time was 22.96 +/- 16.26 seconds in patients and 10.23 +/- 16.26 seconds in controls (p < 0.001). Spectral analysis of the variability of the R-R interval showed an increase in the parasympathetic component both in the lying and standing position compared to controls. The other autonomic nervous system function tests showed no significant difference between obese patients and controls. CONCLUSIONS: These results suggest that obese patients present a reduction of oesophageal transit and autonomic nervous system dysfunction albeit no direct correlation was found between these phenomena.

Adult↗
PubMed2001

Adult constipation: a review and clinical guide.

Constipation is a common complaint that can be a symptom of serious disease. Awareness of the potential etiologies can help direct the history, physical exam and subsequent work-up for the presenting individual. This article details the differential diagnosis and pathophysiology of constipation based on a review of the literature. The article is also designed to be useful as a guide to the work-up of constipation. Key elements of the history, physical exam and testing are outlined. Included is a detailed flow diagram to guide the work-up of constipation. Testing methods and their value in the evaluation of chronic idiopathic constipation are discussed. Finally, although the focus of this article is the evaluation of constipation, a section on the treatment of constipation is included.

Adult↗
PubMed2005

Comparison between coefficient of R-R interval variation and gastric emptying in type 2 diabetes mellitus patients.

BACKGROUND: Autonomic neuropathy is a common complication of diabetes mellitus (DM). METHOD: To clarify the relationship between cardiovascular autonomic function and gastric emptying rate, we investigated the gastric emptying and coefficient of R-R interval variation (CV(RR)) of 84 type 2 diabetic patients: 28 cases without peripheral neuropathy and 56 cases with peripheral neuropathy. All patients were subjected to a gastric emptying test according to the marker method (administration of a capsule containing 20 pieces of radiopaque marker during breakfast, followed by abdominal X-ray imaging 3 and 5 h later). Patients had their CV(RR) assessed at rest and during deep breathing. RESULTS: Gastric emptying scores were significantly correlated with CV(RR) during deep breathing and with the duration of DM, but neither age nor CV(RR) at rest in all patients. Gastric emptying scores and CV(RR) at rest and during deep breathing in patients with peripheral neuropathy were significantly deteriorated than those in patients without peripheral neuropathy. A significant correlation between gastric emptying and CV(RR) during deep breathing could be observed in the patients with peripheral neuropathy, but not in those without it. CONCLUSIONS: These findings showed that CV(RR) during deep breathing might be a good indicator of diabetic gastropathy and that peripheral neuropathy was closely related with cardiac and gastric autonomic neuropathy in the type 2 diabetic patients.

Aged↗
PubMed2005

Real-time monitoring of a digestive tract marker to reduce adverse effects of moving organs at risk (OAR) in radiotherapy for thoracic and abdominal tumors.

PURPOSE: To evaluate the feasibility of real-time monitoring of a fiducial marker in/near the digestive tract and to analyze the motion of organs at risk to determine a reasonable internal margin. METHODS AND MATERIALS: We developed two methods to insert a fiducial marker into/near the digestive tract adjacent to the target volume. One method involves an intraoperative insertion technique, and the other involves endoscopic insertion into the submucosal layer of the normal digestive tract. A fluoroscopic real-time tumor-tracking radiotherapy system was used to monitor the marker. RESULTS: Fourteen markers (2 in the mediastinum and 12 in the abdomen) were implanted intraoperatively in 14 patients with no apparent migration. Seventeen of 20 markers (13/14 in the esophagus, 1/2 in the stomach, and 3/4 in the duodenum) in 18 patients were implanted using endoscopy without dropping. No symptomatic adverse effects related to insertion were observed. The mean/standard deviation of the range of motion of the esophagus was 3.5/1.8, 8.3/3.8, and 4.0/2.6 mm for lateral, craniocaudal and anteroposterior directions, respectively, in patients with intrafractional tumor motion less than 1.0 cm. CONCLUSION: Both intraoperative and endoscopic insertions of a fiducial marker into/near the digestive tract for monitoring of organs at risk were feasible. The margin for internal motion can be individualized using this system.

Abdominal Neoplasms↗
PubMed2006

A review of digestible microsystems for gastrointestinal tract diagnostic applications.

Present methods for investigation of the GI tract are invasive, distressing for the patient, and give a low diagnostic yield. Wireless, radio telemetry capsules, capable of monitoring physiological changes or visualizing the GI tract are noninvasive and could realize a faster time to diagnoses along with improved treatment of both organic diseases and functional disorders. Consequently, the patient's quality of life would improve. In this paper, early radiotelemetry capsules and the motivating factors for their development are discussed. Following this, prototype and commercially available digestible microsystems making use of microelectronics and microelectromechanical systems are presented. It is shown that these capsules have the potential to combine the functions of their predecessors and furthermore can be used for visualizing the gastrointestinal tract. These systems have the potential to improve diagnostic yield and, in the future, treatment of disease using these capsules should become a reality.

Capsules↗
PubMed2006

[Development and applications of a gastrointestinal monitoring microsystem based on the smart capsule].

A newly-developed gastrointestinal (GI) monitoring system based on a smart capsule is presented in the paper. The unprecedented 130-200 hours battery life and smaller size (10 mm x 20 mm) allows the physician to get total pan-colonic measurements of high-amplitude propagating contractions (HAPCs). To test the in vivo performance of the monitoring system, 15 healthy volunteers and 10 patients with slow transportation constipation (STC) participate in this study. The average of HAPCs occurred in patients is significantly lower than in volunteers (12.4 +/- 3.3 vs. 18.5 +/- 3.7 p = 0.013). The system provides a useful tool for STC diagnosis and treatments of patients.

Adult↗
PubMed2002

[Audit procedure of radiology reports in a hospital service].

PURPOSE: Presentation of a clinical audit of the radiology reports in our institution. MATERIAL: and methods: This audit has been performed in several steps: launching the project, elaboration of the reference book, elaboration of the protocol, analysis of the results, improvements made. RESULTS: Several dysfunctions were detected: typing errors, the lack of sentences explaining the procedure of examination, the lack of negative pertinent elements, the lack of synthesis. Several interventions were made: checking on the screen of the computer the report before signing it, purchase of personal voice recorders, restructuring the interpretation room. Other interventions are considered: structured data entry, P.A.C.S. systems CONCLUSION: This audit has allowed the modification of the process for realisation of the radiology reports and the stimulation of the medical team, thus improving the quality of our work.

Clinical Protocols↗
PubMedDate not supplied

[New medical pH probes for the examination of the gastrointestinal system].

The paper deals with pH-probes with mercurius chloride versus silver chloride electrodes for intragastric pH-metry. Present-day oral, transnasal, and endoscopic pH-probes with reusable epicutaneous silver chloride electrode have been designed and introduced into medical practice.

Diagnostic Techniques, Digestive System↗
PubMed2003

Motility and GI function studies billing and coding guidelines: a position paper of the American Motility Society.

Tests that measure gastrointestinal function, such as esophageal motility testing, ambulatory twenty-four hour pH, electrogastrography, gastroduodenal, sphincter of Oddi, and anorectal manometry, as well as hydrogen breath testing are now an essential part in the evaluation of patients with functional gastrointestinal disorders. They are widely performed in a variety of clinical settings. In this paper we outline the position of the American Motility Society on billing and coding for these studies, and review the issues for these studies under the current United States Relative Value Scale system. We have also provided an outline for standardization of reports for these procedures, and propose changes and modifications of current medical necessity diagnoses.

Diagnostic Techniques, Digestive System↗
PubMed1999

[Validation of a diagnostic scoring system (Ohmann score) in acute appendicitis].

A diagnostic scoring system, recently published by Ohmann et al. in this journal, was validated by analyzing the clinicopathological data of a consecutive series of 2,359 patients, admitted for suspicion of acute appendicitis. The results of the scoring system were compared to the results of clinical evaluation by junior (provisional) and senior surgeons (final clinical diagnosis). To assess the diagnostic ability of the score, the accuracy and positive predictive value were defined as the major diagnostic performance parameters; the rate of theoretical negative laparotomies and that of diagnostic errors served as the major procedural performance parameters. Of 2,359 patients admitted for suspected acute appendicitis, 662 were proven to have acute appendicitis by histology, for a prevalence of 28%. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the provisional clinical diagnosis were 0.50, 0.94, 0.77, 0.83, and 0.82; 0.93, for the score 0.63, 0.93, 0.77, 0.86 and 0.84, and for the final clinical diagnosis 0.90, 0.94, 0.85, 0.96, and 0.93, respectively. Of the main diagnostic performance parameter, the accuracy of the score was significantly better than that of provisional clinical diagnosis (P < 0.05, chi 2 test). The score yielded a rate of negative appendecomies and laparotomies of 14.3 and 12.3%. With respect to the rate of overlooked cases of acute apendicitis, the score demonstrated a superior performance, with only 6 cases missed (0.9%). However, the number of patients with acute appendicitis, including those with perforated disease, who were not identified by the score, was almost four times that of the final clinical diagnosis (245 vs 63). With regard to the main procedural performance parameter, the score resulted in a significantly smaller number of diagnostic errors than the provisional clinical investigator (P < 0.05, chi 2 test). The results of this study indicate that the diagnostic scoring system might be helpful when experienced investigators or additional diagnostic modalities such as ultrasonography are not available. It may therefore be of value in the preclinical evaluation of patients with suspected acute appendicitis and may be instrumental as a quality control tool and in clinical guidelines.

Acute Disease↗
PubMed2004

Diagnosis and grading of gastritis by non-invasive optical analysis.

OBJECTIVES: The precise identification of many diseases of the gastrointestinal tract requires the histological analysis of multiple biopsies of the lining mucosae, thus preventing an immediate diagnosis and the safe screening of the entire organ. To address these limitations, we developed a novel spectroscopic procedure for a real-time, non-invasive optical analysis of mucosae. METHODS: We have used a fibre-optic probe that monitors light propagation through small tissue volumes to evaluate the antral and fundic mucosa of 51 patients that underwent gastroscopy for symptoms of dyspepsia. Several optical coefficients were computed from the recorded light reflectance, and confronted to the diagnosis made by an expert gastroscopist at the time of the clinical examination. Both evaluations were then validated by comparison with the histological diagnosis of a pathologist who screened biopsies taken at the sites of the optical measurements. RESULTS: We report that the optical procedure discriminated normal and pathological gastric mucosae with a higher sensitivity and specificity than endoscopic diagnosis. We also show that the changes in light-scattering coefficient, which permitted the optical diagnosis of gastritis alterations, were indirectly correlated with the extent of inflammatory infiltration of the mucosa and detected mucosal alterations mild enough to escape endoscopic detection. CONCLUSIONS: The results show that, in a normal clinical setting, the optical in vivo analysis provided by our system detects alterations typical of gastritis, and allow for their graded scoring with a specificity and sensitivity that compare well with those of standard histology, while avoiding the invasiveness of the latter procedure. The method is adaptable to the screening of other types of lesions and mucosae and, hence, should prove useful in improving available diagnostic approaches.

Diagnostic Techniques, Digestive System↗
PubMedDate not supplied

Intestinal neuronal dysplasia type B: one giant ganglion is not good enough.

In this "Current Practice in Pediatric Pathology" article, 2 experts in the field and an associate editor of Pediatric and Developmental Pathology discuss the definition, diagnosis, clinical significance, and management of intestinal neuronal dysplasia type B. Intestinal neuronal dysplasia type B has constituted a diagnostic challenge ever since its first description more than 30 years ago. Intestinal neuronal dysplasia type B is regarded by many as a subtle malformation of the enteric nervous system that is limited to the submucosal plexus of the colon. The precise etiology remains unknown, and, to date, no specific diagnostic test exists other than morphology. Over time, with increasing experience, obligate pathological features have been adapted and refined, leading to contemporary diagnostic criteria that are enunciated in this review and placed into context with prior published data. Rigorous application of these criteria, under standardized laboratory conditions, is crucial for accurate diagnosis and future advances in this field.

Child, Preschool↗