Clinical significance of multi slice spiral CT in the diagnosis of small intestinal diseases / 中国基层医药

Objective@#To explore the clinical significance of multi slice spiral CT in the diagnosis of small intestinal diseases.@*Methods@#78 patients suspected with small intestinal diseases were selected and scanned by multi detector row spiral CT instrument.The lesion position, size, type, range and distant metastasis were observed.Then, the clinical and pathological results were compared and analyzed.@*Results@#The final clinicopathological diagnosis had 49 positive cases, 29 negative cases among the 78 patients.The MDCTE had 40 positive cases, which had correspondence with pathological diagnosis; 29 negative cases had correspondence with pathological diagnosis; 9 cases had been misdiagnosed.The sensitivity of MDCTE in diagnosis of small intestinal diseases was 81.63%(40/49), the specificity was 100.00%(29/29), the positive predictive rate was 100.00%(40/40), the negative predictive rate was 76.32%(29/38), the accuracy of diagnosis was 88.46%[(40+ 29)/78].@*Conclusion@#MDCTE has important clinical significance in the diagnosis of small intestinal diseases.

Diagnostic and Therapeutic Value of Single-balloon Enteroscopy in Suspected Small Intestinal Diseases / 胃肠病学

Background:Single-balloon enteroscopy(SBE)is a new method for the examination of small intestine,its clinical value in suspected small intestinal diseases need to be further studied. Aims:To evaluate the diagnostic and therapeutic value of SBE in suspected small intestinal diseases. Methods:A total of 73 suspected small intestinal diseases patients who had undergone 81 SBE examinations from July 2011 to October 2013 at Chengdu Military General Hospital were retrospectively examined,indications,diagnostic and therapeutic value of SBE in suspected small intestinal diseases were analyzed. Results:Of all the 81 examinations,33(40. 7% )were obscure gastrointestinal bleeding,29(35. 8% ) incomplete intestinal obstruction,and 19(23. 5% )chronic abdominal pain or diarrhea. The intubation depth was 230 cm for the oral approach,and 100 cm for the anal approach. The diagnostic yield of SBE was 67. 9% ,the main lesions were small intestinal ulcer,small intestinal inflammation,small intestinal tumor,small intestinal polyp. A total of 8 patients underwent endoscopic therapy,of whom 5 underwent endoscopic hemostatic therapy and 3 underwent resection of polyp. No serious complications were found. Conclusions:SBE is a safe and reliable diagnostic and therapeutic method for suspected small intestinal diseases,and its main indications are obscure gastrointestinal bleeding and incomplete intestinal obstruction.

Diagnostic value of CT virtual endoscopy on the small intestine lesions / 中国综合临床

Objective To investigate the diagnostic value of CT virtual endoscopy on the small intestine (CTVE)technology for intestinal diseases. Methods Forty-nine cases with suspected small bowel disease were tested by CTVE from December 2010 to February 2014. They also were performed. Results Of 49 patients, operation or electronic endoscopy showed that 9 cases were benign tumors,29 cases with malignant tumors,3 cases with intestinal polyps,4 cases with intestinal inflammation,2 cases with bowel dysfunction and 2 cases with normal intestinal. CTVE test showed that 11 cases were with benign tumors,29 cases with malignant tumors,2 cases with intestinal inflammation,1 case with intestinal polyps,4 cases with intestinal dysfunction and 2 cases with normal small intestine. Better consistency between the two diagnosis was seen(Kappa = 0. 70). The accurate rate of diagnosis was 85. 71%(42 / 49). The correct rate of CTVE diagnosis of space occupying lesions was 90. 24%(37 / 41). The correct rate of non occupied lesions was 50. 00%(3 / 6). Conclusion CTVE technology has the advantages of simple operation,safe,painless,and clinical diagnosis of small bowel disease rate is higher especially for small bowel accounted disease. It is worthy of clinical application.

Clinical Research on Therapeutic Methods of Small Intestinal Diseases in TCM / 世界科学技术-中医药现代化

This study was aimed to further explore theory of small intestinal diseases and its principle of syndrome differentiation and treatment and lay the base for the clinical study, through the clinical research on the treatment of small intestinal diseases. Through the clinical survey among 584 patients, using Traditional Chinese Medicine (TCM) Clinical Multidimensional Relational Query System, which was established by the research on the clinical individual diagnosis and treatment evaluation system on the prevention and treatment of diseases, to conduct the multidimen-sional relational analysis on small intestinal diseases' disease-symptoms-syndromes-therapy-medicines-effects. Using data mining and statistical methods, such as WEKA, Business Objects, SPSS to mine and analyze the syn-dromes and symptoms. The results showed that commonly-used TCM methods on treatment of small intestinal dis-eases, therapeutic principles of main syndromes of small intestinal diseases were summarized. It was concluded that through scale-free network diagram analysis on the commonly-used treatment of small intestinal diseases, the main treatment methods included promotion the flow of qi, relieving pain, tonifying spleen, removing dampness, clearing away heat, mildly regulating cold and heat. And the treatment methods of dispersing cold, invigorating blood circula-tion and removing blood stasis, nourishing yin, moistening and loosening bowels, abductively dispersing food stagna-tion were also used. It corresponds with the results of clinical research.

Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption.

Background & objectives: Aetiology of malabsorption syndrome (MAS) differs in tropical and temperate countries over time; clinical and laboratory parameters may differentiate between various causes. This study was undertaken to investigate the spectrum of MAS among Indian adults and to find out the features that may help to differentiate between TM and celiac disease. Methods: Causes of MAS, and factors differentiating tropical malabsorption (TM) from celiac disease (CD) were determined in 275 patients. Results: Using standard criteria, causes in 275 patients [age 37.5+13.2 yr, 170, (61.5%) male] were, TM 101 (37%), CD 53 (19%), small intestinal bacterial overgrowth 28 (10%), AIDS 15 (5.4%), giardiasis 13 (5%), hypogammaglobulinemia 12 (4%), intestinal tuberculosis 7 (2.5%), strongyloidiasis 6 (2%), immunoproliferative small intestinal disease 5 (2%), Crohn's disease 6 (2%), amyloidosis 4 (1.5%), intestinal lymphangiectasia 3 (1%) and unknown 22 (8%). On univariate analysis, patients with CD were younger than TM (30.6+12 vs. 39.3+12.6 yr, P<0.001), had lower body weight (41.3+11.8 vs. 49.9+11.2 kg, P<0.001), longer diarrhoea duration (median 36 inter-quartile range 17.8-120 vs. 24-months, 8-48, P<0.01), lower stool frequency (6/day, 5-8 vs. 8, 5-10, P<0.05), lower haemoglobin (9.4+3.2 vs. 10.4+2.7 g/dl, P<0.05), higher platelet count (2,58,000, range 1,35,500-3,23,500 vs. 1,60,000, 1,26,000-2,58,000/mm3, P<0.05), and more often had hepatomegaly (9/53, 17% vs. 4/101, 4%, P<0.01), and subtotal or partial villous atrophy (36/50, 72% vs. 28/87, 32%, P<0.001). Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were significant on multivariate analysis. Interpretation & conclusions: TM and CD are common causes of MAS among Indian adults. Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were found to be associated with CD.

Guiding value of capsule endoscopy for access route of double-balloon endoscopy / 中华消化内镜杂志

Objective To evaluate the guiding role of capsule endoscopy (CE) in choosing the access route of double-balloon enteroscopy (DBE) for small bowel diseases. Methods Patients with complete CE and with small bowel diseases confirmed by DBE were enrolled. The lesion location found on CE was represented by the time index, which was the ratio of access time from pylorus to lesion over access time from pylorus to ileocecal valve. Based on our previous retrospective evaluation, oral approach was selected when the index was ≤0. 6, otherwise the anal access would be chosen. Accuracy of time index predicting DBE access rout was evaluated. Results Data of 60 patients undergoing both CE and DBE were evaluated. All lesions detected by CE were confirmed by DBE, with 41 via oral route and 19 via anus. Based on the time index with threshold of 0.6, the accuracy of selecting the insertion route of DBE was 100%. Conclusion DBE is an effective approach to confirm CE results. In patients with complete small bowel investigation by CE, the insertion route for DBE can be reliably indicated with time index based on the CE results.

The diagnosis of 68 patients with small intestinal diseases by double-balloon enteroscopy / 中华消化杂志

Objective To evaluate the diagnostic value, patients' tolerance and complications of double-balloon enteroscopy (DBE) in the diagnosis of small intestinal diseases. Methods During May 2003 to July 2005, a total of 68 patients (36 men, 32 women; mean age of 52. 6 years, range 15-78 years) with suspected small intestinal diseases were performed double-balloon enteroscopy (36 via mouth, 25 via anus and 7 via both mouth and anus according to suspected lesion location). Among them, obscure recurrent gastrointestinal bleeding was found in 39 cases, incomplete small intestinal obstruction in 7 cases, chronic abdominal pain in 14 cases, and chronic diarrhea in 8 cases. Results Approximately one half to three-fourth of the entire small intestine was observed by each approach in all cases except for 3 cases of severe intestinal stricture. The observation of the whole small intestine was finished by the combination of both oral and anal approaches in 7 cases. The appropriate use of X-ray made the enteroscopy easier and more helpful to determine the extent and location of the lesions. The lesions were found in 41 of the 68 patients, with a total positive rate of 60. 3%. The diagnostics yields was 26/39(62. 6%) in obscure recurrent gastrointestinal bleeding, 5 in incomplete intestinal obstruction, 6/14(43%) in chronic abdominal pain and 4 in chronic diarrhea, respectively. Fifty-seven cases (83. 8%) tolerated well without anesthesia while 11 cases received propofol anesthesia. No procedure-related severe adverse events or severe complications such as hemorrhage or perforation occurred in all cases. Conclusion Double-balloon enteroscopy is a well-tolerated and safe diagnostic approach with a high diagnostic yield in small intestinal diseases.