Hepatitis C Infection in Hemodialysis Patients.

Three centuries after the identification of hepatitis C virus (HCV), specialized literature has outlined the epidemiology, viral kinetics and clinical manifestations of this infection. A major cause of morbidity-mortality in patients with renal transplantation and in hemodialysis patients is HCV infection. In high seroprevalence countries, internal accounts are not uniform. The European trend is to decrease the incidence and prevalence of HCV in hemodialysis patients. In Europe, the prevalence of HCV infection among hemodialysis patients tends to be higher than that of the general population, but it is variable by region. Some studies indicate a decrease in incidence in parallel with prevalence in dialysis centers over the last 10 years, while others maintain a high incidence. In some countries, as is the case with Romania, both prevalence and incidence remain high, with the major route of transmission being nosocomial, probably due to limited resources for a rapidly growing dialyzed population. Some authors recommend more isolation measures to be taken in centers with high prevalence of infection.

Telangiectasia Detection in Wireless Capsule Endoscopy Using the Color Slicing Technique.

Wireless capsule endoscopy represents a color imaging technology in the field of medical endoscopy that is extensively used to detect lesions of the human digestive tract. It is the golden standard in evaluating small bowel lesions, offering a set of digital snapshots difficult to get using other investigation methods. Its major drawbacks are the time consumed for image analysis and the burden for the physicians that must spot and classify lesions within more than 55000 images. This paper carries out a study on the detection of telangiectasia in the small bowel, based on an adapted color slicing technique applied not only on unique frames, but on series of successive frames, performing a global analysis suitable on partial sequences or entire wireless capsule endoscopy movies. We have quantified the extracted features and determined a weighting algorithm to find telangiectasia lesions. For frames containing potential lesions, we have determined features not only for the global image, but also for the normal mucosa surrounding the lesion extracted from the image. This approach allows the physician to see variations of parameters within a frame or a sequence that contains lesions. Experimental results prove that the algorithm is effective in detecting telangiectasia patterns of different images, with an accuracy of 93.88%, reducing thus the time spent for the analysis of the images acquired by wireless capsule endoscopy.

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

Feasibility Study of a Novel Navigation System for Biopsy of Peripheral Lesions in the Lungs.

A novel system for electromagnetic navigation in bronchoscopy (ENB) to improve peripheral lesion targeting and diagnostic is currently under development, and preliminary tests on a complex phantom are presented in this paper. The system named Transbite is proving to be easy to use, accurate and useful for experienced and beginner users, with precision around 5-9 mm in reaching targets in sub-segmental bronchi where a conventional video-bronchoscope cannot extent. Transbite system consists of a planning and orientation software, a navigation and biopsy forceps, an active marker that is placed on patient chest and an electromagnetic tracking system from the market connected to a computer containing the software. Transbite can be used with any bronchoscopy system, has a short set-up procedure and learning curve.

Study of Pulmonary Hypertension in Patients Suffering from Chronic Obstructive Pulmonary Disease.

Pulmonary hypertension (PAH) represents a frequent complication in patients suffering from chronic obstructive pulmonary disease (COPD), but the impact of accelerated inflammatory status on the pulmonary vascular bed is still insufficiently studied. OBJECTIVES: The study of the PAH's prevalence in patients suffering from COPD, its severity compared with lung function and the correlation with certain clinical, biological and functional parameters. MATERIAL AND METHOD: The study was performed on a group of 64 patients, average age 53 years, 42 of whom were men (65,62%), suffering from COPD who were admitted to the Emergency County Hospital Craiova, on the II-nd Medical Clinic, within a period of 18 months. When assessing the patients their clinical state was stable, without acute exacerbations items. The control group included 61 patients suffering from other diseases without inflammatory background, who were hospitalized in clinic in the same period. All the patients included in the study were evaluated by: physical examination, thoracic radiological examination, spirometry, inflammatory syndrome, echocardiography Doppler and oximetry. RESULTS: The results of the study show a prevalence of 54.6 % PAH and a statistically significant impact of age, duration of the disease, Sa O2, inflammatory status, which was quantified in the study by ESR, serum levels of CRP and serum level of TNF alpha over the risk of developing COPD in patients suffering from PAH. CONCLUSIONS: The occurrence and the severity of PAH in patients suffering from COPD seems to be correlated with their age, duration of the disease, Sa O2 and serum levels of inflammatory markers.

Hepatocellular Carcinoma in Diabetic Patients - a Single Center Experience.

INTRODUCTION: Hepatocellular carcinoma (HCC) represents a major health concern worldwide; identifying risk factors and associated conditions that may lead to its development are therefore of utmost importance to the medical community. An association between diabetes mellitus (DM) and development of HCC on underlying liver conditions has been previously suggested. The aim of our study is to reveal possible significant statistical correlations between the two entities, which might warrant further study of the pathophysiological mechanisms behind this association. PATIENTS AND METHODS: We have prospectively included consecutive cirrhotic patients admitted to our medical clinic over a period of four years, between 2010 and 2014. Diagnostic was established using the EASL criteria. We have documented history of hyperglycemia and any changes of serum values in these patients, evaluating DM patients within the LC lot. From these patients we have selected all patients with imaging suggestive for HCC and established positive diagnosis on the criteria established in the latest EASL guidelines. We have used statistical tests to identify possible correlations between these pathologies. RESULTS: We have identified 2718 consecutive patients with LC and successfully included 2556. Of these, 164 also had HCC. A total of 371 patients had DM - 54 also had HCC while 317 remained cancer-free through our study period. We found positive correlations between the presence of DM and HCC. Subgroup analysis of the HCC cohort revealed a positive association between DM and liver cirrhosis and chronic hepatitis. We did not find positive relationships between DM and overall liver conditions, splenomegaly, hepatomegaly, other significant symptoms, substance abuse and main serum values. CONCLUSIONS: We have found several significant correlations between DM and underlying liver conditions in a HCC cohort. Our study, however, did not reveal other significant associations regarding these diseases. Further studies are required to determine the precise role this disease plays in the development and severity of liver diseases.

The Evaluation of Beta-2-Adrenoreceptors' Expression in Normal Peritumoral Tissue in Patients with Colorectal Adenocarcinoma.

INTRODUCTION: The aim of this study is to evaluate the expression of beta-2 adrenergic receptors in the normal peritumoral tissue at the colorectal level, just after the front tumor invasion, in patients with colorectal cancer. METHODS: In this study we analyzed normal peritumoral tissues belonging to 56 patients, who were diagnosed with colorectal adenocarcinoma. These tissues were fixed in paraformaldehyde and paraffinembedded. The immunohistochemical study was done on seriate slides following the hematoxylin and eosin staining, after diagnostic and grading. Correlations were made between beta-2-adrenoreceptors' expression in the normal peritumoral tissue and the clinical and histopathological parameters of the patients with colorectal cancer. RESULTS: There are positive correlations between the expression of beta-2-adrenoreceptors and feminine gender, age group under 50 years, tumor size under 5cm, tumor invasion T3-4 and tumor metastasis in regional lymph nodes N≥2. By analyzing the expression of beta-2-adrenoreceptors in peritumoral tissue depending on tumor grading one can notice that there are positive correlations between beta-2-adrenoreceptors' expression and poorly differentiated colorectal adenocarcinoma. CONCLUSIONS: Positive correlation between this type of receptors in normal glandular epithelium, in the vicinity of tumor invasion front of colorectal neoplasm, and certain clinicopathological features suggests the involvement of tumor microenvironment, which expresses them, in the pathogenesis of this neoplasm.

Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis.

INTRODUCTION: Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract. PATIENTS AND METHODS: 30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena. RESULTS: The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions). CONCLUSIONS: The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer.

Diabetes mellitus and renal involvement in chronic viral liver disease.

HYPOTHESIS: Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. OBJECTIVES: Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement. METHODS AND RESULTS: We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus. DISCUSSION: Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.

Neutrophil Gelatinase Associated Lipocalin (NGAL) - a biomarker of renal dysfunction in patients with liver cirrhosis: Do we have enough proof?

RATIONALE: Renal dysfunction has a serious impact on the natural evolution of liver cirrhosis. Treatment and prognosis may be improved if an early diagnosis could be established, and specific therapeutic interventions would be applied. Although RIFLE and AKIN classifications have been successfully implemented in the clinical practice of Nephrology and Intensive Care Units, these did not provide major improvements in patients with liver cirrhosis. In the last decade, various biomarkers of kidney injury have been assessed, and Neutrophil Gelatinase-Associated Lipocalin (NGAL) is one of the most promising and most studied novel biomarker. OBJECTIVE: To offer a brief evaluation on current data on the utility of this biomarker in patients with liver cirrhosis. METHODS AND RESULTS: We have searched through current literature and analyzed all significant full text articles on this topic. DISCUSSIONS: NGAL and other new kidney injury molecules may be useful in patients with liver cirrhosis, particularly in identifying structural kidney dysfunction, but larger validation studies to confirm this observation are needed.

Wireless Capsule Endoscopy in Correlation with Software Application in Gastrointestinal Diseases.

Wireless capsule endoscopy is one of the most recent investigation techniques of gastrointestinal pathology. Unlike conventional upper and lower endoscopy, it has the advantages of being a noninvasive and painless procedure. One of the capsule endoscopy disadvantages is represented by the necessary time to analyze the video frames obtained. Software applications proposed in this purpose could offer support in the images evaluation. Different algorithms have been described in the literature, but further research is needed to establish the practical value of computer vision tools in gastroenterology.

Particularities of Renal Manifestations in Chronic Viral Hepatitis.

INTRODUCTION: Chronic viral hepatitis represent major health problems worldwide, with an evolution that is sometimes marked by a series of extrahepatic manifestations. Among these, kidney disease may occur, either as glomerulonephritis, and/or renal dysfunction. MATERIAL AND METHODS: The purpose of this study was to achieve a complete assessment of the liver and kidney function in a series of patients diagnosed with chronic viral hepatitis, in order to identify a possible kidney disease in this context. 104 patients with chronic viral hepatitis B and C, aged between 25 and 80, were included in the study. These patients were assessed by a series of tests that allowed us to perform a complete evaluation of both liver and kidney function: liver cytolysis enzymes, serum bilirubin, markers of cholestasis, markers of viral infection, urinalysis, albuminuria, electrophoresis of urinary proteins, urea, creatinine, and abdominal ultrasound. RESULTS: Glomerular injury was a rare finding in patients with chronic hepatitis. Patients with chronic hepatitis B had glomerular disease in 5,88 % of cases, while 10 % of the patients with hepatitis C presented this type of renal disease. Acute kidney injury was not identified in our patient group. None of the patients in the hepatitis B study group presented chronic kidney disease. CKD was present in two patients with chronic hepatitis C that had no other associated conditions.

The Recovery Physical Therapy Effects upon the Ventilation Dysfunction in Patients with Ankylosing Spondylitis.

Purpose - The evaluation of the ventilation function improval in patients with ankylosing spondylitis following the medical recovery procedures. Methods - The study included 24 patients that were diagnosed with AS stages I and IV that were monitored for 24 months. We recorded ventilation functional tests, respiratory gas levels, thorax involvement in inspiration and expiration, the medical, physical and balneotherapy that they had followed. The activity of the disease was evaluated using the BASDAI score. The evaluation of the functional disability was based on the BASFI score and the life quality needed the QLQ questionnaire. The age of the disease has started was also considered. Results - The study included 24 patients, 22 men and two women (11/1 men/female ratio), ages between 35 and 55 years. The disease has begun 18 plus or minus 2 years before. After 24 months a significant improval was noticed concerning the restrictive ventilation dysfunction specific parameters and also an increase of oxygen pressure by 7 plus or minus 2 mmHg. Conclusions - The constant and correct application of respiration recovery and the spine mobility procedures lead to better life quality regarding the patients with AS and the main parameters that evaluate ventilation dysfunction.

Contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver lesions - a prospective multicenter study of its usefulness in clinical practice.

PURPOSE: To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types. MATERIAL AND METHODS: CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications. RESULTS: A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm. CONCLUSION: CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).

Stress in romanian first year nursing students.

OBJECTIVE: This study aims to analyze the stress of the students from the nursing department within the Medical Midwife and Nurse School from our University. SUBJECTS AND METHODS: For this purpose a questionnaire, comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. RESULTS: The result analysis revealed no significant differences as far as the genders of the subjects were concerned. In the same way, the prior academic background or the student experience did not influence the level of stress. The social and economic factors seem to be involved in choosing a career and thus influence the academic stress. For this purpose, a questionnaire comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. We used the Students t-test to determine differences between groups and considered p<0.05 as significant. CONCLUSIONS: The stress equally affects the nursing department students, regardless of their gender or prior studies. Social and economic factors play a role in adapting to a new academic environment, having higher expectations and requirements.

Histopathological and immunohistochemical study of hepatic stellate cells in patients with viral C chronic liver disease.

OBJECTIVE: Our aim was to establish a correlation between hepatic stellate cells (HSCs) activity within different areas of hepatic tissue and the degree of liver fibrosis, necroinflammation, and steatosis in patients with viral C chronic liver disease. PATIENTS AND METHODS: We prospectively included 41 liver biopsies from patients with chronic hepatitis C or liver cirrhosis, prior to antiviral treatment. Our control group consisted of seven tissue samples, obtained from 10 to 38 weeks old embryos. We assessed the alpha-smooth muscle actin (α-SMA) expression using immunohistochemistry and a semi-quantitative scoring method. RESULTS: We found a strong correlation (p<0.0001) between the number of activated HSCs and the stage of fibrosis in all examined areas. Necroinflammatory activity was significantly correlated (p<0.05) with the number of activated HSCs in perivenular area (p=0.014) and intermediate area (p=0.018), and strongly correlated (p<0.0001) in periportal and portal tracts and fibrous septa areas. We found no correlation between the degree of steatosis and the number of activated HSCs in the perivenular area (p=0.25), intermediate area (p=0.166) and in the periportal area (p=0.154); however, in the portal tracts and fibrous septa area we observed a significant correlation (p=0.022). CONCLUSIONS: The analysis of HSCs activity within specified areas of liver tissue may lead to new perspectives in early diagnosis of liver fibrosis and in the development of future antifibrinogenic therapies.

Clinical, evolution and therapeutical considerations upon a case of fibrodysplasia ossificans progressiva (FOP).

Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant genetic transmitted disease, with a rare incidence (1-2 cases/million persons) and it usually affects female patients. Its manifestations include acute pain episodes that tend to repeat, involving the soft tissue and the axial muscles with later appearance of ectopic bone tissue in ligaments, joints and tendons. In the great majority of times, the skeletal modifications are observed at birth but the first clinical symptoms occur at 2-4 years old. The clinical symptoms include pain and inflammation of the soft tissue, sometimes associated with fever and cutaneous erythema, joint symptoms--pain, stiffness most frequently concerning the scapular and pelvic girdle, bone malformations--short hallux, microdactilia, kyphoscoliosis, thorax malformations. The diagnosis is established based on the clinical symptoms and the imagistic investigations: CT, MRI - which indicate the joint modification and the ectopic bone tissue. Muscular biopsy is not indicated as it leads to new lesions in the already traumatized areas.

Macroscopic and microscopic findings in avascular necrosis of the femoral head.

UNLABELLED: The avascular necrosis of the femoral head is an illness induced by the cutoff of blood flow to the femoral head and it affects mostly young adults between the ages of 30 and 50 years, raising therapeutic and diagnostic issues. Many risk factors are incriminated in the development of avascular necrosis of the femoral head like: trauma, chronic alcohol consumption, smoking, administration of corticosteroid drugs, most of the cases are considered to be idiopathic. The main goal of our paper is to describe the macroscopic and microscopic variations of the bone structure, which occur in patients with avascular necrosis of the femoral head. MATERIALS AND METHODS: The biological material needed for our study was obtained following hip arthroplasty surgery in 26 patients between the ages of 29 and 59 years, which previously were diagnosed with avascular necrosis of the femoral head and admitted in the Orthopedics Department of the Emergency County Hospital of Craiova (Romania) between 2010 and 2011. From a macroscopic point of view, we found well defined areas of necrosis, most of which were neatly demarcated of the adjacent viable tissue by hyperemic areas, loss of shape and contour of the femoral head and transformations of the articular cartilage above the area of necrosis. When examined under the microscope, we found vast areas of fibrosis, narrow bone trabeculae, obstructed blood vessels or blood vessels with clots inside, hypertrophic fat cells, bone sequestration but also small cells and pyknotic nuclei. The microscopic and macroscopic findings on the femoral head sections varied with the patients and the stage of the disease.

Association between liver histology, carotid ultrasonography and retinal vascular changes in patients with nonalcoholic fatty liver disease (NAFLD).

INTRODUCTION: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing all over the world. NAFLD has been demonstrated to be associated with carotid artery atherosclerosis, evaluated using the intima-media thickness (IMT). In this article, we focused on the association between NAFLD, carotid parameters such as: intima-media thickness (IMT), pulsatility index (PI) and resistivity index (RI) as markers of subclinical atherosclerosis and the presence of retinal vascular disorders. PATIENTS AND METHODS: We compared carotid IMT, pulsatility and resistivity index evaluated by ultrasonography, in 10 patients with histological-proven NAFLD and retinal vascular changes (retinophotographies). RESULTS: The degree of hepatic steatosis, necroinflammation and fibrosis in NAFLD patients was strongly associated with the value of carotid IMT and also with PI and RI. Moreover, there seems to be a connection between the degree of NAFDL and the retinal vascular changes in patients with carotid atherosclerosis. CONCLUSIONS: These results suggest that the severity of liver histopathological lesions among NAFLD patients is strongly associated with carotid parameters: IMT, IP, IR and also with retinal vascular changes. Further controlled studies are needed to confirm the results.

The role of capsule endoscopy in the detection of small bowel disease.

Videocapsule endoscopy (VCE) can identify lesions in the small bowel which would otherwise be hard to detect. We have selected 53 patients with digestive symptoms in which upper and lower endoscopy had provided no findings. Patients were classified into three groups, based on their main indication for VCE exploration: group one--obscure gastrointestinal bleeding (OGIB); group two--unspecific abdominal symptoms; group 3--monitoring of a prior known pathology. We found that VCE has high predictive values, sensibility and specificity in the diagnosis of OGIB. VCE was also useful in the detection and extent evaluation of lesions in Crohn's and celiac disease. VCE is also able to detect tumors of the small bowel with sufficient accuracy, and can be used to monitor patients with hereditary pre-malignant diseases such as FAP. There were few light adverse effects and no major complications. We conclude that VCE is a safe and effective procedure for the detection of small bowel lesions.