[Acute complications after endoscopic resection of duodenal adenomas]. / Akutkomplikationen nach endoskopischer Resektion von Duodenaladenomen.

With the increasing technological development of endoscopy in recent years the diagnosis of and endoscopic therapy for duodenal adenomas has gained in importance. Due to its potentially malignant transformation an effective and safe therapy is necessary. The endoscopic resection has been shown to be safe and effective, even in cases of resection of large duodenal adenomas. Several studies have supported this thesis but are based on relatively small numbers of patients. In our clinic we have performed endoscopic resections of 178 duodenal adenomas over a period of 14 years, including sporadic duodenal adenomas as well as adenomas in familial polyposis syndromes. The aim of this retrospective analysis was to determine the acute complications associated with this technique. The rate of severe complications such as major bleeding or perforations was 9%. Further complications were minor bleeding (15.7%), pain needing treatment with analgesia (6.7%), fever (2.8%) and pancreatitis (0.6%). Summing up our experience with the endoscopic resection of adenomas of the small bowel we also consider the endoscopic resection of duodenal adenomas in most cases as a safe and effective alternative to surgical therapy. Because of the potential complications and their management especially in the resection of large adenomas with a size more than 2 cm, the endoscopic resection should be performed on an inpatient basis in experienced centres.

Vaginal colonization by probiotic Lactobacillus crispatus CTV-05 is decreased by sexual activity and endogenous Lactobacilli.

BACKGROUND: Two potencies of gelatin capsules containing Lactobacillus crispatus CTV-05 were evaluated for safety and vaginal colonization in 90 young women. METHODS: Sexually active females aged 14-21 years were randomized to receive either 10(6)- or 10(8)-cfu CTV-05 capsules inserted intravaginally twice daily for 3 days. At enrollment and at 4 weekly follow-up visits, behavioral and demographic information and quantitative vaginal cultures were collected. Lactobacillus species were identified by DNA hybridization, and the CTV-05 strain was discerned using repetitive-sequence polymerase chain reaction DNA fingerprinting. RESULTS: Of the 90 participants, 87 returned for at least 2 follow-up visits. Of 40 participants who lacked L. crispatus colonization at enrollment, 36 (90%) were successfully colonized by CTV-05 at 1 or more follow-up visits, whereas only 24 (51%) of 47 participants colonized by L. crispatus at enrollment were positive for CTV-05 at follow-up (P < .001). Compared with sexually abstinent participants, females engaging in sexual intercourse with the use of condoms (odds ratio [OR], 6.3 [95% confidence interval {CI}, 1.3-29.4]; P = .02) or having unprotected sex (OR, 75.5 [95% CI, 6.9-820.6]; P < .001) during the first week were less likely to become colonized by CTV-05. CONCLUSIONS: These data suggest that the factors that predict failure to become colonized by probiotic lactobacilli include exposure to semen, vaginal intercourse, and the presence of lactobacilli of the same species at enrollment.

[Complications in double-balloon-enteroscopy: results of the German DBE register]. / Ergebnisse des deutschen Registers für die Doppelballonenteroskopie.

INTRODUCTION: The introduction of double-balloon enteroscopy for the investigation of the small bowel in 2001 was a milestone in GI endoscopy because it allows us to carry out therapeutic interventions as well as diagnostic procedures in the small bowel. Because interventional procedures in endoscopy increase the risk of complications, e.g., in colonoscopy and only limited data were reported regarding the risk of DBE, we introduced a double-balloon enteroscopy register (DBE Register) in Germany. AIM AND METHODS: The purpose of this study was to evaluate the complication rate of DBE in a larger group of patients. We contacted all endoscopic units using DBE in Germany in January 2006 and asked for their participation in the register, the examination data and their present complications beginning in January 2003 until 15.07.2006 using a questionnaire. RESULTS: The participation rate of 85 endoscopic centres using the DBE technique was 75 % (64 centres). They reported 3894 DBE examinations (2685 using the oral route, 1209 using the anal route) with 1086 interventions. 48 complications were reported (1.2 %). Acute pancreatitis occurred in 9 patients with 1 lethal course of disease, all of them receiving a DBE using the oral route. Thus, the pancreatitis rate after oral DBE was 0.34 %. Perforation happened in 8 cases, all of them needed surgery. One patient died during the course of the disease. 6 perforations occurred after polypectomy, so the perforation rate after polypectomy during DBE is 3.4 % in this study. In 6 cases major bleeding was reported, 4 in the context of polypectomy and 2 after biopsy. All patients received endoscopic treatment and recovered from this complication. CONCLUSION: DBE is in this by now largest collection of cases a safe endoscopic procedure with an overall complication rate of approximately 1%. For diagnostic DBE pancreatitis is the most frequent complication and has to be taken in consideration in the written informed consent.

[Peutz-Jeghers syndrome: endoscopic detection and treatment of small bowel polyps by double-balloon enteroscopy]. / Diagnostik und Therapie von Dünndarmpolypen mittels Push-and-Pull-Enteroskopie in Doppelballontechnik bei Patienten mit Peutz-Jeghers-Syndrom.

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is characterised by a combination of hamartomatous gastrointestinal polyps and mucocutaneous melanin pigmentation. The polyps occur mainly in the small bowel and can lead to intestinal obstruction, intussusception and bleeding. Until only a few years ago, primary surgical resection and intraoperative endoscopy and polypectomy were the only available means of treating polyps in the mid-small bowel in these patients. With the introduction of double-balloon enteroscopy (DBE), we now have not only an improved diagnostic tool but also a non-surgical treatment option. METHODS: Between March 2003 and September 2006 a total of 16 patients with PJS were examined by DBE and treated endoscopically. The size, number and location of the diagnosed and endoscopically resected small-bowel polyps were documented as were all complications associated with the examination or treatment. RESULTS: A total of 47 DBE-procedures were performed (oral approach 39, anal approach 8). The examinations revealed a total of 178 polyps. 47 polyps were removed by endoscopic polypectomy on the grounds of their size and/or gross appearance. The largest small-bowel polyp resected was 50 mm (min. 15 mm, max. 50 mm). A total of four complications occurred (2 episodes of bleeding with a fall in Hb, 1 perforation, 1 propofol-associated decrease in oxygen saturation). CONCLUSION: DBE is a safe and reliable procedure for the diagnosis of small-bowel polyps in patients with PJS. In addition to macroscopic assessment and biopsy of suspicious areas, it permits the exact localisation as well as preoperative marking of polyps that are primary candidates for surgery. DBE revolutionises the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.

Design of a difference-frequency infrared laser spectrometer for absorption line-shape studies.

An infrared laser spectrometer based on difference-frequency generation in LiIO(3) is described. The spectrometer has a frequency uncertainty of less than 1 MHz and a signal-to-noise ratio between 3000:1 and 10,000:1. These properties allow the spectrometer to be used for studies of the non-Lorentzian and non-Voigt character of absorption line shapes in atmospheric trace gases.

Comparison of API 50 CH strips to whole-chromosomal DNA probes for identification of Lactobacillus species.

The API 50 CH identification system was evaluated for the identification of 97 strains of commensal lactobacilli. This system agreed with the species-level identifications for none of the 7 reference strains and only 4 of 90 vaginal isolates identified using whole-chromosomal DNA probes.

Colonization of the rectum by Lactobacillus species and decreased risk of bacterial vaginosis.

Lactobacilli colonizing the rectum may be a reservoir for vaginal lactobacilli. In a cross-sectional study of 531 females, vaginal and rectal colonization by lactobacilli were assessed by culture methods. A subset of isolates was identified to the species level by use of whole-chromosomal DNA probes. Lactobacillus crispatus (16%), L. jensenii (10%), and L. gasseri (10%) were the prevalent lactobacilli colonizing the rectums of 290 females. Only 13 (9%) of 147 females colonized by L. crispatus or L. jensenii vaginally and/or rectally had bacterial vaginosis (BV), compared with 12 (44%) of 27 females colonized by other H(2)O(2)-producing lactobacilli (P < .001). Cocolonization of the vagina and rectum by H(2)O(2)-producing lactobacilli was associated with the lowest prevalence of BV (5%), whereas females colonized only vaginally, only rectally, or at neither site had a successively increased risk of BV (P < .001). Lactobacillus species in the rectum may contribute to the maintenance of vaginal microflora.

Broadening and line mixing in the 20 (0)0<--01 (1)0, 11 (1)0<--00 (0)0 and 12 (2)0<--01 (1)0 Q branches of carbon dioxide: experimental results and energy-corrected sudden modeling.

Using both a difference frequency spectrometer and a Fourier transform spectrometer, we have measured transitions in the 12 (2)0<--01 (1)0 band of carbon dioxide at room temperature and pressures up to 19 atm. The low-pressure spectra were analyzed using a variety of standard spectral profiles, all with an asymmetric component to account for weak line mixing. For this band, we have been able to retrieve experimental line strengths and the broadening and weak mixing parameters. In this paper we also compare the suitability of the energy-corrected sudden model to predict mixing in the two previously measured Q branches 20 (0)0<--01 (1)0, the 11 (1)0<--00 (0)0, and the present Q branch of pure CO(2), all at room temperature.

Lactobacillus crispatus capsules: single-use safety study in the Macaca nemestrina model.

BACKGROUND: Lactobacillus crispatus is a part of the normal vaginal microflora of humans. GOAL: The goal of this study was to assess whether a capsule containing an H2O2-producing strain of L crispatus (CTV-05) would alter the vaginal microflora and/or epithelial tissues when applied intravaginally in the pig-tailed macaque model. STUDY DESIGN: Ten sexually mature female Macaca nemestrina were assessed at baseline for quantitative vaginal microbiology and vaginal pH and with colposcopy. One capsule containing 108 colony forming units of desiccated L crispatus CTV-05 was inserted into the vaginal fornix of each animal. Vaginal assessments were repeated on days 1 and 2 after capsule insertion. The L crispatus CTV-05 strain was identified with use of a DNA fingerprinting method. RESULTS: Before product use, four of 10 animals had detectable levels of H2O2-producing lactobacilli. L crispatus CTV-05 was detected in 1 of 10 animals on day 1 and in 3 of 10 animals on day 2 following insertion of the capsule. There were no tissue changes observed by colposcopy. Vaginal pH decreased in two animals colonized by CTV-05, from 7.0 at baseline to 4.5+/-0.5 on days 1 and 2 after product use. CONCLUSIONS: A single intravaginal application of capsules containing 108 L crispatus CTV-05 resulted in vaginal colonization in three of 10 animals 2 days after use. The absence of colposcopic changes in the vagina/cervical tissues indicates that L crispatus capsules are well tolerated.

DNA fingerprinting of Lactobacillus crispatus strain CTV-05 by repetitive element sequence-based PCR analysis in a pilot study of vaginal colonization.

Lactobacillus crispatus is one of the predominant hydrogen peroxide (H(2)O(2))-producing species found in the vagina and is under development as a probiotic for the treatment of bacterial vaginosis. In this study, we assessed whether DNA fingerprinting by repetitive element sequence-based PCR (rep-PCR) can be used to distinguish the capsule strain of L. crispatus (CTV-05) from other endogenous strains as well as other species of vaginal lactobacilli. Vaginal and rectal lactobacilli were identified to the species level by using whole-chromosome probe DNA hybridization. The DNAs from L. crispatus, L. jensenii, L. gasseri, and an as-yet-unnamed H(2)O(2)-negative Lactobacillus species designated 1086V were subjected to rep-PCR. The results of gel electrophoresis and ethidium bromide staining of the DNA fingerprints obtained were compared. L. crispatus CTV-05 had a unique DNA fingerprint compared to all other lactobacilli. DNA fingerprints for 27 production lots of L. crispatus sampled from 1994 through 2001 were identical to that of the original strain isolated in 1993, suggesting strain stability. In a pilot study of nine women, this DNA fingerprinting method distinguished CTV-05 from other endogenous vaginal lactobacilli prior to and after vaginal capsule use. rep-PCR DNA fingerprinting is useful for strain typing and for evaluating longitudinal loss or acquisition of vaginal lactobacilli used as probiotics.

Digital divider circuit for a laser-beam-pointing stabilization system.

Adigital divider circuit is used in a feedback circuit that is designed to stabilize laser-beam pointing.

Principles of an intracavity polarimeter for measuring small optical anisotropies with an application to diffractive dichroism.

An intracavity polarimeter is described that is capable of measuring both weak birefringence and dichroism simultaneously. It uses, for the first time to our knowledge, polarization flips in a quasi-isotropic He-Ne laser. The laser operates at 3.39 µm. Calibration of the polarimeter is carried out by using the anisotropic properties of a tilted plate. As an illustration of the sensitivity, the diffractive anisotropy of an intracavity slit is measured.

Dichroism and birefringence in aperiodic coupled cavities and their influence on the polarization states of quasi-isotropic lasers.

We show that aperiodic coupled cavities may be designed to have a frequency-dependent complex reflectance that is anisotropic in phase (birefringent) and in amplitude (dichroic). The complex mean or average reflectivity may also be frequency dependent. As an illustration we show how such multicavity effects influence the stability of the polarization of light in quasi-isotropic lasers. Possible applications of the properties of aperiodic coupled cavities are suggested.

Spectroscopic technique for measuring the temperature and pressure cycle of a pressure modulator radiometer.

Precise spectral line measurements of carbon monoxide in an operating pressure modulator cell permit independent determinations of the instantaneous gas temperature and pressure.

Absolute Raman frequency measurement of the Q(2) line in D(2) using cw CARS.

Coherent anti-Stokes Raman spectroscopy (CARS) is combined with high-resolution interferometry to measure the absolute Raman shift of the Q(2) vibrational line in D(2). The preliminary value found is 2987.237(1) +/- 0.001 cm(-1). Such precision is essential for the testing of ab initio energy-level calculations for the hydrogen isotopes.

Multireflection Raman cell: a design.

The construction and some of the calculations for a new multireflection Raman cell are described. The cell has a small volume, may be used at high pressures and low temperatures, and is intended for use with a laser and a spectrometer. The cell constructed yields a scattered light signal 4 to 5 times that possible with an optimum double pass laser illuminated cell. Higher gains can be achieved by altering the cell dimensions.

Digitally pressure-scanned fabry-perot interferometer for studying weak spectral lines.

A system is described for digitally scanning a Fabry-Perot interferometer by changing the pressure of the gas in the interferometer chamber by small discrete steps. The system, intended for recording weak signals, i.e., of the order of a few counts per second, is very linear. Repetitive scans are reproduced within 1/640 of the spectral free range of the interferometer. An example of the depolarized Rayleigh line scattered by H(2) at 2.5 amagat is given.