ABSTRACT
BACKGROUND: Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of capsule endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. METHODS: Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using capsule endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using capsule endoscopy and push enteroscopy. RESULTS: On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before capsule endoscopy was used. Definitive bleeding sites were diagnosed by push enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push enteroscopy localised an additional bleeding source in comparison with capsule endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. DISCUSSION: The present study shows that capsule endoscopy had the highest diagnostic yield and was superior to push enteroscopy in patients with chronic gastrointestinal bleeding. By using the capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.
Subject(s)
Endoscopes, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Image Processing, Computer-Assisted/instrumentation , Intestinal Diseases/diagnosis , Intestine, Small , Video Recording/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Capsules , Chronic Disease , Diagnosis, Differential , Equipment Design , Female , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Diseases/pathology , Intestinal Diseases/surgery , Intestinal Mucosa/pathology , Intestinal Mucosa/surgery , Intestine, Small/pathology , Intestine, Small/surgery , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificitySubject(s)
Duodenal Ulcer/therapy , Gastric Outlet Obstruction/therapy , Peptic Ulcer Hemorrhage/therapy , Peptic Ulcer Perforation/therapy , Stomach Ulcer/therapy , Anti-Bacterial Agents , Anti-Ulcer Agents/administration & dosage , Drug Therapy, Combination/administration & dosage , Duodenal Ulcer/etiology , Gastric Outlet Obstruction/etiology , Humans , Laparoscopy , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Perforation/etiology , Proton Pump Inhibitors , Randomized Controlled Trials as Topic , Risk Factors , Stomach Ulcer/etiologyABSTRACT
A cardioselective parameter has been available for about 2 years since the development by KATUS of an immunoassay for cardiac Troponin T (TnT). The major advantages of this TnT assay are its cardiospecificity and its sensitivity. The parameters usually determined in toxicity studies in rats to detect alterations in the myocardial cells, e.g. aspartate aminotransferase (ASAT), creatinine kinase (CK) and lactate dehydrogenase (LDH), are either of low sensitivity in this species or give falsely high results as the consequence of stress or haemolysis. We therefore investigated in the present study how well Troponin T, determined with the ELISA Troponin T from Boehringer Mannheim, can detect experimentally induced myocardial lesions in rats. In order to achieve hypoxic damage of the cardiomyocytes in these experiments in rats, male Sprague-Dawley rats were given two doses of 4 mg/kg isoprenaline each (Aludrin from Boehringer Ingelheim, FRG) subcutaneously. The second dose was given 7 h after the start of the experiment. Serum samples were analysed for Troponin T (TnT) levels and, for comparison, aspartate aminotransferase (ASAT), creatine kinase (CK), and lactate dehydrogenase (LDH). Histological examinations of the heart muscle were performed 24 and 96 h after the first injection. As expected, histological examinations of the isoprenaline-treated animals revealed marked myofibrillic degeneration of the myocardium 24 h after the first injection. Markedly elevated serum TnT levels (up to 7.9 ng/ml) were already evident in these animals after 6 h. TnT values decreased with time, but were still statistically significant after 48 h. Of the well-established indicators for diagnosing myocardial infarction, only ASAT showed transient statistically significant increases over 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cardiomyopathies/diagnosis , Myocardium/chemistry , Troponin/analysis , Animals , Aspartate Aminotransferases/analysis , Biomarkers/analysis , Cardiomyopathies/chemically induced , Cardiomyopathies/pathology , Creatine Kinase/analysis , Isoproterenol/toxicity , L-Lactate Dehydrogenase/analysis , Male , Myocardium/enzymology , Myocardium/pathology , Rats , Rats, Inbred Strains , Troponin TABSTRACT
A spinn immunoassay for diphenylhydantoin is reported, which appears to give an accurate and precise estimate of serum diphenylhydantoin concentrations, as judged by the disappearance of [14C]diphenylhydantoin from the serum of a rabbit. The assay also appears to be a reliable technique for routine diphenylhydantoin determinations, as judged from our experience with 28 patients. Serum diphenylhydantoin concentrations in the range of 1.0-50.0 mg/liter are easily determined on a 50-mul sample. Except for primidone, no significant cross reactivity was observed with eight drugs that are commonly used in conjunction with diphenylhydantoin therapy. This fast, simple, and precise method therefore appears to be readily applicable to routine determination of diphenylhydantoin.
