ABSTRACT
Re-usable air/water and suction valves used in endoscopes often demonstrate risk of infection. To the authors' knowledge, the safety and efficacy of re-usable and single-use valves have not been compared to date. As such, a laboratory investigation was undertaken to compare the safety and efficacy of re-usable and single-use valves at 11 Italian endoscopy sites. Safety was evaluated by analysing the rinse liquid of reprocessed re-usable valves ready for use, and efficacy was assessed based on the completion of endoscopic procedures without valve malfunction. This study found significantly lower contamination of single-use valves compared with re-usable valves (0 vs 29.1%, respectively; P=0.007) and similar efficacy (97.6 vs 98.8%, respectively; P=ns). Microbiological analysis of the rinse liquid of reprocessed re-usable valves identified various surviving micro-organisms and highlighted their potential pathogenicity. Such data suggest that sterile single-use valves may be safer than re-usable valves, and have comparable performance.
ABSTRACT
OBJECTIVE: To investigate the efficacy and tolerability of octatropine methyl bromide plus diazepam (Valpinax) in patients with irritable bowel syndrome (IBS). MATERIALS AND METHODS: We conducted a randomized, double-blind, multicentre study in 186 patients aged 18-65 years with IBS diagnosed according to Rome II criteria. Following a 2-week washout period, patients received octatropine plus diazepam 40 mg/2.5 mg twice daily or placebo for 6 weeks. The primary efficacy endpoint was response to a weekly question: "did you have satisfactory relief of your abdominal pain and discomfort during the last week?" Other endpoints included abdominal swelling, abdominal pain and discomfort, symptom severity, and the number of bowel movements. A prespecified subgroup analysis was conducted in patients with an abdominal pain and discomfort score > or = 3. RESULTS: The primary efficacy endpoint showed a tendency towards a statistically significant benefit for octatropine plus diazepam over placebo among patients with a baseline abdominal pain and discomfort score of > or = 3 (3 vs. 0 patients; p = 0.059). Octatropine plus diazepam demonstrated significant improvements from baseline in all parameters assessed, but not compared with placebo. Adverse events were reported in 15.1% of patients receiving octatropine plus diazepam. CONCLUSIONS: Patients with IBS and an abdominal pain and discomfort score of > or = 3, who may be considered in the active phase of the disease, may derive some benefits from octatropine plus diazepam. This study highlights that Rome II criteria should be considered with particular care in the design of a clinical trial, since it does not consider disease activity level on admission.
Subject(s)
Diazepam/therapeutic use , Gastrointestinal Agents/therapeutic use , Irritable Bowel Syndrome/drug therapy , Tropanes/therapeutic use , Abdominal Pain/drug therapy , Abdominal Pain/etiology , Adolescent , Adult , Aged , Defecation/drug effects , Diazepam/adverse effects , Double-Blind Method , Drug Combinations , Female , Gastrointestinal Agents/adverse effects , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/physiopathology , Italy , Male , Middle Aged , Pain Measurement , Severity of Illness Index , Time Factors , Treatment Outcome , Tropanes/adverse effects , Young AdultSubject(s)
Lung Neoplasms/secondary , Osteosarcoma/secondary , Soft Tissue Neoplasms/pathology , Thigh , Adult , Female , HumansSubject(s)
Immunoproliferative Small Intestinal Disease/diagnostic imaging , Adolescent , Humans , Immunoglobulin A/metabolism , Immunoproliferative Small Intestinal Disease/complications , Immunoproliferative Small Intestinal Disease/immunology , Malabsorption Syndromes/etiology , Male , Middle Aged , RadiographyABSTRACT
Coeliac disease is a primary malabsorption syndrome, whose gastrointestinal symptomatology regresses following a gluten-free diet. Several authors report an increased incidence of intestinal lymphoma in patients with longstanding coeliac disease; on the other hand the association of this malabsorption syndrome with malignant tumors of the esophagus, stomach or large bowel is not very common. The authors describe three cases of coeliac disease complicated after 5, 12 and 18 years by neoplasms of the esophagus, stomach and small bowel. It is stressed that in this disease patients must be monitored with periodic radiologic examinations, in the hope of detecting any malignancy at an early and perhaps treatable stage.
Subject(s)
Celiac Disease/complications , Esophageal Neoplasms/etiology , Ileal Neoplasms/etiology , Jejunal Neoplasms/etiology , Stomach Neoplasms/etiology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/etiology , Adult , Esophageal Neoplasms/diagnostic imaging , Female , Follow-Up Studies , Humans , Ileal Neoplasms/diagnostic imaging , Jejunal Neoplasms/diagnostic imaging , Lymphoma/diagnostic imaging , Lymphoma/etiology , Male , Middle Aged , Radiography , Stomach Neoplasms/diagnostic imagingABSTRACT
Our study was directed not only towards the diagnosis of small bowel Crohn's disease, but especially to a quantitative analysis, for a correct therapeutical approach. This experimental trial is based on the relationship between radiological evidence, measured during small bowel enema, and the seriousness of the morphological and functional damage to the intestinal mucosal membrane, evaluated with a post-heparin diamine-oxidase activity test. With this method we studied 35 selected patients; 16 of them were affected by the disease with an exclusive localization in the small bowel and 5 have been considered separately, because 3 patients had already been operated and the other 2 showed different localizations. In our results, the two parameters were not constantly related to each other. In other words the enema's morphological data sometimes do not accord with the mucosal membrane integrity index expressed by the enzyme. Anyway the importance of this study is the attempt of making an objective comparison between an anatomic situation and its functional consequence. These aspects have a great significance in Crohn's disease.
Subject(s)
Amine Oxidase (Copper-Containing)/blood , Crohn Disease , Intestine, Small/diagnostic imaging , Barium Sulfate , Crohn Disease/diagnostic imaging , Crohn Disease/enzymology , Humans , Methylcellulose , RadiographyABSTRACT
Malabsorption syndrome is a clinical condition that can be determined by several situations which can ensue by many etiopathogenetic mechanisms. While the diagnostic approach is, for this reason, complex and uses a lot of clinical, laboratory and instrumental techniques, the therapeutic approach could be surgical or medical. The aim of our research is to establish the diagnostic utility of the radiologic examination of the small intestine by enteroclysis, on the basis of our personal experience and the data referred in literature. We took particular care of the radiological study of primitive malabsorption.
Subject(s)
Intestine, Small/diagnostic imaging , Malabsorption Syndromes/diagnostic imaging , Barium Sulfate , Celiac Disease/diagnostic imaging , Crohn Disease/diagnostic imaging , Humans , Immunoproliferative Small Intestinal Disease/diagnostic imaging , Intestinal Neoplasms/diagnostic imaging , Lymphoma/diagnostic imaging , Malabsorption Syndromes/chemically induced , Malabsorption Syndromes/etiology , RadiographyABSTRACT
Segmental ischemic disease consists of segmental infarctions and ischemic stenoses. Vasculitis (LES, polyarteritis nodosa, Schönlein-Henoch syndrome), thrombosis, arteriosclerotic changes, mechanical obstructions (adhesions, hernia, volvulus, traumas), hemorrhagic disorders are the most common causes of these intestinal lesions. The authors report their experience achieved during three years on 428 small bowel examinations; among these, 197 were double contrast enemas. Ten patients showed roentgenographic features referred to vascular diseases: 1 LES, 1 Schönlein-Henoch syndrome, 3 polyarteritis nodosa, 5 spontaneous hemorrhagic disorders or due to treatment with anticoagulants. The authors, after a review of the radiological findings, emphasize the high sensitivity and low specificity of double contrast small bowel enema. Furthermore they underline the usefulness of this method in demonstrating and monitoring intestinal pathologic changes.
Subject(s)
Intestine, Small/blood supply , Ischemia/diagnostic imaging , Barium Sulfate , Constriction, Pathologic/diagnostic imaging , Humans , Intestinal Obstruction/diagnostic imaging , Intestine, Small/pathology , Ischemia/etiology , Ischemia/pathology , Mesentery/blood supply , Mesentery/diagnostic imaging , RadiographySubject(s)
Diverticulum/diagnostic imaging , Intestine, Small , Adult , Diverticulum/etiology , Female , Humans , Male , RadiographySubject(s)
Adenomatous Polyposis Coli/diagnostic imaging , Gardner Syndrome/diagnostic imaging , Adult , Barium Sulfate , Enema , Female , Humans , Male , Methylcellulose , RadiographyABSTRACT
In mechanical subocclusions, when there isn't immediate urgency, is it possible and necessary to probe radiologic examination, for a better surgical evaluation. The authors describe their own experience, achieved in about 3 years, on small bowel double contrast enema. They examined 143 patients; 16 of them were suboccluded. The security and the diagnostic reliability of used method are stressed by the authors to define lesions' morphology and localization.