Dye chromoendoscopy leads to a higher adenoma detection in the duodenum and stomach in patients with familial adenomatous polyposis.

Backround and study aims Duodenal cancer is the cancer most often seen in patients with familial adenomatous polyposis (FAP) who have undergone risk-reducing colonic surgery. Almost all patients with FAP eventually develop duodenal adenomas and risk for duodenal cancer is up to 12 % with poor prognosis. In addition, there is a rising concern regarding increased gastric cancer risk in patients with FAP. Our aim was to enhance polyp detection by using CE (CE) with the application of indigo carmine dye. Patient and methods We conducted a prospective, blinded study of patients with FAP undergoing endoscopic examination of the upper gastrointestinal tract. First, a standard white-light examination (WLE) was done followed by an examination performed by an endoscopist who was blinded to the previous examination, using chromoendoscopy (CE) (0.4 % indigo carmine dye). Results Fifty patients were included in the study. Using WLE, a median number of 13 adenomas (range 0-90) was detected compared to 23 adenomas/patient (range 0-150; P  < 0.0001) detected after staining, leading to a higher Spigelman stage in 16 patients (32 %; P  = 0.0003). CE detected significantly more larger adenomas (> 10 mm) than WLE (12 vs. 19; P  = 0.0391). In the gastric antral region, a median number of 0 adenomas (range 0-6) before and 0.5 adenomas (range 0-7) after staining ( P  = 0.0025) were detected. Conclusion This prospective endoscopic trial, to our knowledge the largest in patients with FAP, showed a significant impact of CE on adenoma detection and therapeutic management in the upper gastrointestinal tract. This leads to more intensive surveillance intervals.

A randomized pilot study of stochastic vibration therapy in spinocerebellar ataxia.

Whole body vibration (WBV) is a biomechanical treatment used widely in professional sports and rehabilitation. We examined the effect of stochastic WBV on ataxia in spinocerebellar ataxia types 1, 2, 3, and 6 (SCA 1, 2, 3 and 6) in a single-center double-blind sham-controlled study. Stochastic WBV was applied on four sequent days, each treatment consisting of five stimulus trains of 60-s duration at a frequency of 6.5 Hz and 60-s resting time between stimuli (n = 17). Patients allocated to the sham group received the same treatment with 1 Hz (n = 15). All patients were rated at baseline and after the last treatment using clinical scores (SARA, SCAFI, and INAS). After treatment, we found significant improvements of gait, posture, and speed of speech in the verum group while limb kinetics and ataxia of speech did not respond. Stochastic WBV might act on proprioceptive mechanisms and could also stimulate non-cerebellar/compensatory mechanisms. But at present, the involved cellular mechanism and the presumed neuronal loops cannot be deciphered. Thus, future work is needed to understand the mechanisms of whole body vibration. Finally, the use of stochastic WBV could provide a supplementation to treat ataxia in SCA and can be combined with physiotherapeutical motor training.

Short review: field recovery and potential information value of small elements of the skeleton.

The recovery of small elements of the skeleton (e.g. hyoid, carpals, and hand and foot phalanges) is one of the established tasks of the archaeologist and physical anthropologist when working in the field, whether in an archaeological or forensic context. In the present work, we illustrate the field location of ossified laryngeal cartilages, hand sesamoids, and the medial clavicular epiphyses. The potential information offered by these elements is briefly summarized. The frequency of these elements observed in a cemetery dating from 1943 indicates the possibility that these elements could be found in other contexts at a higher frequency than expected.

[Basic principles, planning and implementation of non-commercial clinical trials]. / Grundlagen, Planung und Durchführung nichtkommerzieller klinischer Studien.

The proof of a drug's efficacy in randomized controlled trials is fundamental to therapeutic concepts determined by evidence-based medicine. Clinical trials according to the German Medicinal Products Act are performed by the pharmaceutical industry as company-sponsored trials (CST) driven by commercial interests or by non-commercial facilities as investigator-initiated trials (IIT), typically implemented by University Hospitals. In areas with no commercial interest, IITs are the driving force that generate scientific progress leading to treatment optimization. Therefore, non-commercial or investigator-initiated clinical trials are indispensable for improving medical care. To ensure the safety of trial participants and the quality of the data obtained, clinical trials are controlled by many legal regulations and internationally accepted quality standards. Therefore implementation of a clinical trial requires profound knowledge, qualified personnel, appropriate infrastructure, and substantial financial resources. In IITs unlike CSTs this has to be accomplished by the University without the assistance of the pharmaceutical industry. Since teaching of skills needed to perform clinical trials is still largely neglected in medical school and during residency this review addresses the (in clinical trials) inexperienced physician and outlines the characterization of a clinical trial, the range and division of responsibilities and the performance of clinical trials according to the German Medicinal Products Act.

Repeatability of the measurement of augmentation index in the clinical assessment of arterial stiffness using radial applanation tonometry.

OBJECTIVE: Aortic augmentation index (AIx) measured using applanation tonometry is a non-invasive indicator of arterial stiffness. The objective of this study was to assess its repeatability when used by nurses with limited experience of the technique. MATERIAL AND METHODS: Blood pressure/augmentation index (BP/AIx) was measured 4 times in 20 consecutive ambulant patients (16 male) after they rested supine for 15 min. Two nurses independently and alternately measured BP/AIx using the same equipment (Omron HEM-757; SphygmoCor with Millar hand-held tonometer). Nurses were blinded to patient medical records and their colleague's AIx/BP. 'Within' and 'between' observer differences were assessed using intra-class correlation coefficients (rI) and 95 % limits of agreement (95 % LoA) derived from Bland-Altman plots. RESULTS: Mean age was 56 (mean BP 136/79; mean pulse 64). Mean AIx was 24.1 (range 2.8 to 41.0). Both 'between' and 'within' observer repeatability was very high, with intra-class correlation coefficients ranging from 0.92 to 0.98. Mean AIx readings 'between' observers differed by only 0.68 (95 % CI -0.24 to 1.59) with a high rI (0.98; 95 % CI 0.95 to 0.99) and a narrow 95 % LoA (-3.22 to 4.57). The 95 % LoA for 'within' observer repeatability was -6.75 to 7.95. Differences in AIx measurement did not vary over time or with increasing levels of AIx. CONCLUSIONS: Even when undertaken by relatively inexperienced operators, both 'within' and 'between' observer repeatability of AIx measurement is very high. Such non-invasive assessment of arterial stiffness has the potential to be included in the clinical assessment of ambulant patients.