Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial.

BACKGROUND: In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. METHODS: The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. FINDINGS: 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P<0·001). INTERPRETATION: This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

Proper use of quinolones for canine colitis ambulatory treatment: literature review and REQUEST guidelines.

The literature analysed by REQUEST (REassesing QUinolone European STandard) using inclusion and exclusion criteria allows to make the conclusion that the proper use of fluoroquinolones (FQ) in canine colitis requires rigorously performed qualification to specific antimicrobial treatment. An infectious agent responsive to FQ therapy plays an integral role in the clinical manifestation of canine colitis, especially histiocytic ulcerative colitis (HUC) in young Boxer dogs. This supports the use of FQ in these cases. The Request guidelines for proper use of FQ in canine colitis is established, according to the available literature data.

Application of the Sequential Organ Failure Assessment Score to predict outcome in critically ill dogs: preliminary results.

In human medicine the Sequential Organ Failure Assessment (SOFA) score is one of the most commonly organ dysfunction scoring systems used to assess critically ill patients and to predict the outcome in Intensive Care Units (ICUs). It is composed of scores from six organ systems (respiratory, cardiovascular, hepatic, coagulation, renal, and neurological) graded according to the degree of the dysfunction. The aim of the current study was to describe the applicability of the SOFA score in assessing the outcome of critically ill dogs. A total of 45 dogs admitted to the ICU was enrolled. Among these, 40 dogs completed the study: 50 % survived and left the veterinary clinic. The SOFA score was computed for each dog every 24 hours for the first 3 days of ICU stay, starting on the day of admission. A statistically significant correlation between SOFA score and death or survival was found. Most of the dogs showing an increase of the SOFA score in the first 3 days of hospitalization died, whereas the dogs with a decrease of the score survived. These results suggest that the SOFA score system could be considered a useful indicator of prognosis in ICUs hospitalized dogs.

Multiple organ dysfunction syndrome in a dog with Klebsiella pneumoniae septicemia.

Multiple organ dysfunction syndrome is defined as the presence of altered organ function in an acutely ill patient such that homeostasis could not be mantained without intervention. It is reported that mortality rate in humans with 4 organ systems failing reaches nearly 100%, while there are few publications documenting this syndrome in dogs. To the author's knowledge, this is the first report that describes the clinical manifestations and the favourable outcome to intensive medical care in a dog with Klebsiella pneumoniae septicemia and multiple organ dysfunction with 6 organ systems failing. Derangement of cardiovascular, respiratory, gastrointestinal, pancreatic, renal and coagulation system developed. This dog manifested reversible myocardial depression that is a common complication of sepsis in people but it is rarely reported in dogs.

Noncongophilic fibrillary glomerulonephritis in a cat.

This report describes an uncommon case of nonamyloidotic fibrillary glomerulonephritis. A 5-year-old female European cat was presented with nephrotic syndrome. Serum biochemistry and urinalysis revealed a mild increase in cholesterol, low total protein, severe hypoalbuminemia, and high proteinuria with a high protein-to-creatinine ratio. An histologic examination revealed an interstitial nephritis and a diffuse glomerulonephritis, with multifocal thickening of the Bowman's capsule. Transmission electron microscopy showed widespread fibrillary deposits in the glomerular basement membrane and in the mesangium. These fibrils ranged between 18 and 26 nm in diameter and were Congo red negative, which allowed their differentiation from amyloid. Immunohistochemistry demonstrated expression for immunoglobulin M (IgM) and immunoglobulin G (IgG) within the mesangium. Renal deposits of Congo red-negative amyloid-like fibrils have been described in humans, horses, monkeys, and dogs. This is the first report of noncongophilic fibrillary glomerulopathy in a cat.

Oral administration of moxidectin for treatment of murine acariosis due to Radfordia affinis.

A field trial was conducted to assess the safety and efficacy of oral administration of moxidectin in mice naturally infected with the fur mites Radfordia affinis. The natural infection was diagnosed in two colonies within a large academic institution by direct hair examination. Animals received moxidectin (1% Cydectin, FortDodge) at an oral dosage of approximately 2 mg/kg body weight by micropipette; administration was repeated after 15 days. Forty mice served as an untreated control group. Moxidectin treatment resulted in clinical improvement within a few days after initial treatment, and mites were eradicated from all infested animals at day 30. No side effects or signs of ill health were observed in any of the treated animals. To our knowledge, this is the first report of oral moxidectin for treatment of murine acariosis.

[Diagnosis of early gastric marginal zone lymphoma (MALT lymphoma) in endoscopic biopsies. Report of a case that demonstrates the utility of immunohistochemistry and the molecular analysis.]. / Diagnóstico del linfoma de la zona marginal (linfoma MALT) gástrico temprano, en biopsiasendoscópicas. Informe de un caso que ilustrala utilidad de la inmunohistoquímica y el análisis molecular.

MALT lymphomas are a subtype of low grade lymphomas that represent 7-8% of all B-cell lymphomas originated in extranodal sites. Nearly 50% of the cases present as primary gastric lymphomas.They arise from the acquired MALT developed during the course of H. pylori chronic infection. Microscopically,the presence of lymphoid follicles with follicular colonization, marginal zone ("centrocytoid")cells and lymphoepithelial lesions is characteristic.Histopathological diagnosis may result difficult in superficial endoscopic biopsies showing a typical lymphoid infiltrates. Using Wotherspoon criteria along with molecular analyses is useful in borderline lesions. We present the case of a 62 years old female with chronic gastritis. A small endoscopic biopsy was performed and the presence of a heterogeneous lymphoid infiltrate in the lamina propia was observed. Immuno histochemical profile showed focal co expression of CD20 andCD43 and kappa light chain restriction. The diagnosis of an atypical lymphoid infiltrate highly suspicious of MALT lymphoma was established. PCR molecular analysis corroborated the monoclonal pattern of the lymphoid cells and the diagnosis of lymphoma. Immunohistochemical and molecular analyses in cases of lymphoid infiltrates suspicious of malignancy (Wotherspoon 3 and 4) will aid in the adequate diagnosis between chronic gastritis and MALT lymphoma, which is crucial for prognosis,treatment and patient's outcome.Key words: Chronic reactive gastritis, marginal zone lymphoma, MALT lymphoma, gastriclym.

In vitro antimicrobial activity of marbofloxacin and enrofloxacin against bacterial strains isolated from companion animals.

Fluoroquinolones were originally developed for the Gram-negative aerobic spectrum, but the newer generation agents are also highly effective against some Gram-positive pathogens and cause few adverse effects. Owing to these characteristics, fluoroquinolones are often used in first line therapy in small animal practice. However, their widespread use has raised concern over emerging bacterial resistance. In this study we evaluated the in vitro efficacy of two fluoroquinolones, marbofloxacin and enrofloxacin, on field strains isolated from clinical infections between 2002 and 2005. Our data show that most of the isolates are still sensitive to both antimicrobials and marbofloxacin was more effective than enrofloxacin, especially against P. aeruginosa and beta-Streptococci (P < 0.01). beta-Streptococci demonstrated the greatest resistance to the two study drugs.

Measurement of faecal corticoid metabolites in domestic dogs.

In the present study we established a method for the determination of faecal glucocorticoid metabolites in dogs and then used the assay to evaluate the adrenocortical activity in 12 dogs divided into two groups. In group A faecal samples were collected at their domestic setting. In group B, faecal samples were collected at home prior to transport to a boarding kennel, where faecal samples were then collected. In faecal samples most of the steroids were extracted with methanol and determined using a radioimmunoassay with an anti-cortisol antibody. Dogs in group A did not show any statistically significant inter-day variations in the basal levels of faecal corticoid metabolites. Faecal corticoid metabolites in dogs in group B were significantly higher on the first day at the kennel compared to animals kept at home. The peak concentration was found after 24 hours and followed by a slow decline. These results suggest that extraction with methanol and dosage with an anti-cortisol antibody by radioimmunoassay represents a valid approach technique for determination of faecal glucocorticoid metabolites and accurately reflects adrenocortical activity.

Erradicación de várices esofágicas con ligadura recargando un ligador múltiple, comparado con escleroterapia: Un análisis de costo / Rubber band ligation is as effective as sclerotherapy for esophageal varices erradication

La ligadura de várices esofágicas es igual de eficaz que la escleroterapia, pero con menos complicaciones y en menor tiempo. Sin embargo, en nuestro país el costo de los ligadores múltiples ha evitado que este método se haga popular. En nuestra Unidad hemos diseñado un método con el que es posible reutilizar los ligadores múltiples en varias ocasiones, con lo cual se reduce el precio. En este trabajo calculamos el costo de esta modalidad terapéutica, comparada con la escleroterapia habitual en pacientes de nuestra institución. MATERIAL Y METODOS: Se incluyeron todos aquellos pacientes en protocolo de erradicación de várices antes de la introducción de las ligaduras y posterior a las mismas. Las variables estudiadas fueron: edad, sexo, grado de las várices, complicaciones durante el procedimiento, duración del mismo, número de sesiones para erradicar, número de ligas/ml por sesión, una gradación de la facilidad del proce-dimiento en una escala análoga visual (0=muy fácil; 5=muy difícil). El costo total de la erradi-cación, se calculó en base al tabulador de nuestra institución para los procedimientos (en la categoría más cara según trabajo social), así como el costo comercial de los artículos utilizados. De esta manera el costo es: esclero-terapia (Grupo 1): endoscopia: $256.00, polidoca nol al 1 por ciento (utilizando al 3 por ciento y diluyendo) = $7.00, másagujas de escleroterapia (comerciales = desechables) = $224.00, para un total de $487.00. Para ligadura (Grupos 2): endoscopia = $256.00, 6 ligas $12.00, ligador comercial: $1,680.00 (reutilizable hasta 70 veces: $24.00, para un total de $292.00 contra $ 1,936.00 que costaría la sesión si se tuviera que utilizar uno nuevo cada vez. El costo total se calculó: precio por sesión x número de sesiones promedio para erradicar. Si se calculan los precios de acuerdo a los datos de la literatura (4 sesiones para erradicación con ligas), el total es de $1,168.00, aún es muy inferior a la escleroterapia. Este ahorro puede extrapolarse también al ambiente privado. Estos costos son para el paciente institucional, sin embargo varían de acuerdo a su nivel socioeconómico y no reflejan el costo real para la Institución. No obstante es evidente un gran ahorro. CONCLUSIONES: La erradicación de várices esofágicas recargando un ligador múltiple es más económica que la escleroterapia

Effects of the combination antibiotic--EDTA-Tris in the treatment of chronic bovine endometritis caused by antimicrobial-resistant bacteria.

The combined effects of the uterine infusion of EDTA-Tris solution and antibiotics have been evaluated in 75 cases of slight, moderate or severe bovine endometritis which did not respond to local routine antimicrobial therapy. Antibiotic-resistant bacteria were isolated from uterine swabs. The cows were divided into three groups on the basis of the severity of endometritis and treated with 100 ml of sterile EDTA-Tris solution (250 mM EDTA and 50 mM tris, pH 8) and the same antibiotic used in the first unsuccessful treatment (oxytetracycline, enrofloxacin, lincomycin-spectinomycin or amikacin). Control groups consisting of six animals treated with antibiotic alone were used. Clinical evaluations performed 2, 15, 21, 42 and 63 days after treatment revealed good therapeutic results, as 53 cows showed a complete recovery with renormalization of the subsequent oestrus cycle. Artificial insemination was followed by pregnancy in about 90% of treated cows. In control animals the second treatment performed using only the antibiotic gave variable and unsatisfactory results, particularly in animals affected by severe endometritis.

Potentiating effect of EDTA-Tris on the activity of antibiotics against resistant bacteria associated with otitis, dermatitis and cystitis.

Possible synergistic effects of the combination of EDTA-tromethamine (EDTA-Tris) and three antimicrobial agents (cephaloridine, kanendomycin and enrofloxacin) against resistant Gram-positive and Gram-negative bacteria are reported. Bacteria were isolated from eight cases of chronic otitis externa, five cases of chronic dermatitis and four cases of recurrent cystitis in dogs which had previously been treated with one of the three antibiotics without success. Animals exposed to EDTA-tromethamine plus the antibiotic recovered completely within 10 days, and were controlled clinically and bacteriologically for 180 days. Local irrigation with EDTA-tromethamine solution was well tolerated and no side effects were recorded.

[Transrectal endoscopic ileal decompression as treatment of small intestine pseudoobstruction. Report of a case]. / Descompresión ileal endoscópica por vía transrectal como tratamiento de pseudoobstrucción del intestino delgado. Reporte de un caso.

BACKGROUND: Intestinal pseudo-obstruction is a syndrome characterized by recurrent signs and symptoms of intestinal pseudo-obstruction or dilation without any evidence of mechanical pseudo-obstruction. Its cause is unknown, and it is associated with severe alterations of gastrointestinal motility. AIMS: To report the transendoscopic treatment in a case of intestinal pseudo-obstruction as an alternative to a poor response to medical treatment. METHODS: The diagnosis of intestinal pseudo-obstruction was made in a 34-year old male patient who had not responded to conservative treatment; therefore, a colonoscopy was performed and an ileal drainage was introduced with its distal end 50 cm beyond the ileocecal valve. RESULTS: Twenty-four hours after the procedure was performed clinical and radiological improvement was evident. Such improvement was completed at 72 hours when the patient tolerated oral ingestion. CONCLUSIONS: Transrectal ileal drainage could be an alternative to consider in those patients that do not respond to conservative treatment.

Potentiation of antibiotic activity by EDTA-tromethamine against three clinically isolated gram-positive resistant bacteria. An in vitro investigation.

The in vitro synergistic effects of combinations of EDTA-tromethamine and five antimicrobial agents (ampicillin, cephalexin, oxytetracycline, streptomycin and sulphadimethoxine) on three clinically isolated Gram-positive bacteria (Staphylococcus aureus, Staphylococcus hominis and Streptococcus faecium) were investigated. The bacteria had been isolated from three cases of canine otitis resistant to beta-lactam antibiotic therapy. The antimicrobial activity was evaluated by measuring the minimal inhibitory concentration for the antibiotics alone or in combination with EDTA-tromethamine. EDTA-tromethamine potentiated the activity of cefalexin against S. aureus and S. hominis, of oxytetracycline against S. aureus and S. faecium and of streptomycin against S. faecium. No significant effects were noted on the activity of oxytetracycline against S. hominis. The remaining combinations gave a slight synergistic effect. As previously shown for Gram-negative resistant bacteria, these data suggest that the association of EDTA-tromethamine and appropriate antibiotic therapy may be useful to overcome persistent infections of soft tissues in domestic animals.

[Endoscopic management of pyloric stenosis in patients with high surgical risk]. / Manejo endoscópico de la estenosis pilórica en pacientes con alto riesgo quirúrgico.

Pyloric stenosis is a serious complication of acid peptic disease of the stomach. The treatment with balloon dilation by endoscopy has been reported successfully and with few complications. We use a therapeutic endoscope and different diameter dilators during various sessions. We report our experience in 18 patients with high surgical risk and peptic pyloric stenosis during four years (january 1988 to december 1991). Our results were satisfactory and we believe this technique could be used as a valid alternative to surgical procedures in high risk patients.

Potentiation of the in vitro activity of some antimicrobial agents against selected gram-negative bacteria by EDTA-tromethamine.

The in vitro synergistic effects of combinations of EDTA-tromethamine and six antimicrobial agents (ampicillin, chloramphenicol, oxytetracycline, streptomycin, nalidixic acid and sulphadimethoxine) on clinically isolated strains of Pseudomonas aeruginosa, Proteus mirabilis and Escherichia coli were investigated. The antibacterial activity was assessed from the minimal inhibitory concentration for the antibiotics alone or in combination with EDTA-tromethamine. EDTA-tromethamine potentiated the antibacterial activity of ampicillin, chloramphenicol, oxytetracycline and streptomycin up to four-fold. There were no significant or consistent synergistic effects with nalidixic acid or sulphadimethoxine.

[Endoscopic management of postoperative biliary fistulas]. / Manejo endoscópico de fístulas biliares postquirúrgicas.

Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

[Endoscopic management of biliary lithiasis]. / Manejo endoscópico de la litiasis biliar.

The management of bile duct stones is one of the most important contributions of therapeutic endoscopy. It is considered the elective method to treat cholecystectomized patients with recurrent or residual stones as well as those that have high surgical risk, choledocholithiasis and intact gallbladder. Discussion must yet come to terms with those patients that have low surgical risk. Patients with severe biliary pancreatitis have better outcome when they are treated endoscopically, making the procedure an alternative therapeutic approach. Stones are usually removed with balloons or dormia baskets. When the stones can not be extracted or there is a giant stone, endobiliary prostheses or nasobiliary catheters can be used. Materials and techniques are described in this paper.

[The endoprosthetic management of biliary calculi larger than 20 mm: the long-term results]. / Manejo con endoprótesis de la litiasis biliar mayor de 20 mm: resultados a largo plazo.

We present our experiences in fifteen high-risk surgical patients, with large bile duct stones, treated with endoscopic home-made biliary stents. We observed good immediate and mediate results in all patients, with a 19.9 months follow-up. In one case, acute cholangitis developed after 25 months and the patient died. Other three died of unrelated causes. None of the patients required surgery. We conclude that endoscopic stenting is a useful procedure in the treatment of large bile duct stones in poor-risk surgical patients.