Increased polyp detection using narrow band imaging compared with high resolution endoscopy in patients with hyperplastic polyposis syndrome.

BACKGROUND AND STUDY AIMS: Hyperplastic polyposis syndrome (HPS) is associated with colorectal cancer and is characterized by multiple hyperplastic polyps, sessile serrated adenomas (SSAs) and adenomas. Narrow band imaging (NBI) may improve the detection of polyps in HPS. We aimed to compare polyp miss rates with NBI with those of high resolution endoscopy (HRE). PATIENTS AND METHODS: In a single center, randomized crossover study consecutive HPS patients underwent tandem colonoscopy with HRE and NBI, in randomized order with removal of all detected polyps. RESULTS: In 22 patients with HPS, 209 polyps were detected, including 27 with normal histology, 116 hyperplastic polyps, 42 SSAs, and 24 adenomas. Among patients assigned to HRE first (n = 11) a total of 78 polyps was detected; subsequent NBI added 44 polyps. In patients examined with NBI first, 78 polyps were detected and subsequent HRE added 9. Polyp miss rates of HRE and NBI were 36% and 10% (OR 0.21; 0.09-0.45). Flat polyp shape was independently associated with increased miss rate. CONCLUSION: NBI significantly reduces polyp miss rates in HPS patients. We recommend using either NBI or chromoendoscopy for colonoscopic surveillance of HPS patients with removal of all detected polyps.

Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome.

INTRODUCTION: Hyperplastic polyposis syndrome (HPS) is characterised by the presence of multiple colorectal hyperplastic polyps and is associated with an increased colorectal cancer (CRC) risk. For first-degree relatives of HPS patients (FDRs) this has not been adequately quantified. Reliable evidence concerning the magnitude of a possible excess risk is necessary to determine whether preventive measures, like screening colonoscopies, in FDRs are justified. AIMS AND METHODS: We analysed the incidence rate of CRC in FDRs and compared this with the general population through person-year analysis after adjustment for demographic characteristics. Population-based incidence data from the Eindhoven Cancer Registry during the period 1970-2006 were used to compare observed numbers of CRC cases in FDRs with expected numbers based on the incidence in the general population. RESULTS: A total of 347 FDRs (41% male) from 57 pedigrees were included, contributing 11 053 person-years of follow-up. During the study period, a total of 27 CRC cases occurred among FDRs compared to five expected CRC cases (p<0.001). The RR of CRC in FDRs compared to the general population was 5.4 (95% CI 3.7 to 7.8). Four FDRs satisfied the criteria for HPS. Based on the estimated HPS prevalence of 1:3000 in the general population the projected RR of HPS in FDRs was 39 (95% CI 13 to 121). CONCLUSIONS: FDRs of HPS patients have an increased risk for both CRC and HPS compared to the general population. Hence, as long as no genetic substrate has been identified, screening colonoscopies for FDRs seem justified but this needs to be prospectively evaluated.

High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis.

BACKGROUND AND STUDY AIM: Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % - 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of high resolution endoscopy (HRE) and the additional value of chromoendoscopy in the evaluation of duodenal polyposis in FAP. PATIENTS AND METHODS: 43 FAP patients scheduled for surveillance endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining. RESULTS: Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining ( P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas. CONCLUSION: HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. Chromoendoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoendoscopy with side-viewing endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.

[Determination of the novocaine salt of benzylpenicillin]. / Opredelenie novokainovoi soli benzilpenitsillina.

A simple procedure for acidometric titration of procaine benzylpenicillin after its chloroform extraction from alkaline solutions is described. Sodium benzylpenicillin does not prevent the titration.

Alkalimetric determination of amoxycillin trihydrate in non-aqueous medium.

A simple method for determination of amoxycillin by non-aqueous titration in dimethylformamide medium is described. The relative standard deviation is 0.3%.

Determination of thiosemicarbazones by reaction with omega-bromoacetophenone.

Thiosemicarbazones react quantitatively with omega-bromoacetophenone in a suitable medium; hydrobromic acid thus formed is titrated alkalimetrically with Thymol Blue as indicator..

Titration of thiacetazone and isoniazid with sodium methoxide in non-aqueous medium.

Thiacetazone and isoniazid dissolved in dimethylformamide can be accurately titrated with sodium methoxide in benzene-methanol mixture, with o-nitroaniline as indicator. Sodium 4-aminosalicylate does not interfere.

Determination of thioureas by reaction with phenacyl bromide.

Thioureas react quantitatively with phenacyl bromide in ethanolic solution to give hydrobromides of aminothiazoles/iminodihydrothiazoles which can be titrated with sodium carbonate, Thymol Blue being used as indicator.