Capsule endoscopy; the cumulative experience from its use in 193 patients with suspected small bowel disease.

BACKGROUND/AIMS: This study presents our cumulative clinical experience from the use of wireless capsule endoscopy (WCE) in a large series of Greek patients with suspected small bowel (SB) diseases. METHODOLOGY: Over an 18-month period, 193 patients were evaluated with WCE for suspected SB diseases [108 obscure gastrointestinal (GI) bleeding, 32 chronic diarrhea, 22 suspected and 6 diagnosed Crohn's disease, 16 abdominal pain, 4 refractory celiac disease, 3 polyposis syndromes, 1 Rendu-Osler-Weber disease and 1 Behcet disease]. All patients had undergone upper GI endoscopy and total colonoscopy. WCE findings were characterized as specific or non-specific, depending on whether the patient's signs and symptoms could be sufficiently attributed to them or not. RESULTS: One or more abnormal findings were detected in 161/193 (83%) patients; these were classified as specific in 91/193 (47%). The diagnostic yield of WCE (in terms of specific findings) was significantly higher when evaluating patients with obscure GI bleeding, compared to chronic diarrhea (52% vs. 25%, respectively, p=0.013, 95% CI: 1.33-7.83). Among obscure GI bleeders, specific findings were significantly more in the group of overt rather than occult bleeders (66% vs. 42% respectively, p=0.026, 95% CI: 1.19-5.88). In patients referred for diagnosed or suspected Crohn's disease, WCE findings were compatible with the diagnosis in 5/6 cases (83%) and in 8/22 cases (36%), respectively. In 9 more patients from other groups with a negative previous diagnostic work-up, WCE helped in diagnosing Crohn's disease. Among 16 patients evaluated for abdominal pain, specific findings were identified only in 1 (6%). CONCLUSIONS: WCE seems to be a very useful diagnostic tool in the evaluation of GI bleeding of obscure origin (in both overt and occult bleeders), as well as suspected Crohn's disease. In other indications, such as unexplained chronic diarrhea and abdominal pain, it completes the traditional work-up, but abnormal findings need to be better delineated before WCE can be widely recommended in these cases.

Primitive neuroectodermal tumour in a 60-year-old man: a case report and literature review.

Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-old man presented with a PNET. The symptoms at the time of diagnosis were intense headache, Broca's aphasia and right hemiparesis. Only an open biopsy was performed. Irradiation of the primary tumour was the main treatment (total tumour dose 59.8 Gy) because of serious haematological side effects due to chemotherapy. The patient tolerated radiation therapy extremely well and his neurological symptoms were improved. 1 month after completion of radiotherapy, MRI showed no regression of the tumour. Clinical deterioration was observed 10 months after the initial diagnosis and the patient died 2 months later. In cases of PNET, initial therapy is surgical bulk reduction whenever possible. Irradiation of the cerebrospinal axis is justified as a routine treatment but, owing to the radioresistance of the tumour, the addition of multiregimen chemotherapy appears to improve survival, according to the literature.

CT appearance of solitary and multiple cystic and cavitary lung lesions.

Cystic and cavitary lung lesions constitute a spectrum of pulmonary diseases diagnosed in both children and adults. We reviewed the CT findings of the most common cystic and cavitary lung lesions and we defined useful morphological criteria that will help radiologists to distinguish benign from malignant cavitary lesions. However, in many cases the considerable overlap in morphological features of benign and malignant cavities renders transthoracic needle biopsy necessary to establish the correct diagnosis.

Clinical application of percutaneous transluminal angioscopy. Comparison of findings in percutaneous transluminal angioplasty, thrombolysis, thrombus-extraction and stent-application.

Since the introduction of ultrathin angioendoscopes into clinical application, it has been possible to subject the findings of conventional or digital angiography to objective verification. In dogs and in patients, this new angioscopic method for visualization of arteries without surgical intervention has been carried out. The approach is transfemoral. Endoscopy is combined with angiography and, when indicated, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and insertion of a new type of stent. An ultrathin endoscope with an outer diameter of 1.6 mm and a working channel of 0.35 mm is used. Guidewires, contrast media and drugs for local thrombolysis can be employed through this channel. The endoscope is placed in the region of interest under fluoroscopy and direct visualization is obtained by using 0.9% NaCl for decreasing blood flow. Image recording is achieved by video or high-speed camera. With this method, the intraluminal events of dilatation, recanalization, local lysis, stent application and thrombus extraction can be visualized.

[Significance of a transthoracic imaging technic in shoulder arthrography]. / Die Bedeutung der transthorakalen Aufnahmetechnik bei der Schulterarthrographie.

Even in this era of sonography, arthrography of the shoulder is an important diagnostic investigation, making it possible to exclude unrecognized connective tissue lesions in patients with chronic shoulder pain resistant to therapy. Sometimes standard X-ray techniques do not yield all the information the surgeon needs about ventral or dorsal localization of a rotator-cuff rupture. An additional approach to the joint is needed: a transthoracic lateral-view X-ray provides the surgeon with adequate information to help in selection of the most appropriate operative approach to the shoulder.

[After-care problems and complications of percutaneous biliary drainage]. / Nachsorgeprobleme und Komplikationen der perkutanen Gallengangsdrainage.

This is a follow-up study of 171 patients concerning the patients' care and complications following biliary drainage. Complications caused by puncture and drainage are considered separately. External biliary drainage resulted in 39%, internal in 26% with complications. The influence of advantages and side effects upon the indications of biliary drainage is discussed. Prognosis concerning the survival rate depends on the underlying pathology: In obstructive jaundice caused by metastases the patients only survived two months while the mean survival rate in carcinoma of the biliary ducts is 18 months.

Scanning electron microscopic (SEM) studies on the effect of x-ray contrast media on aortic endothelium in the rat.

A study comparing the effects of diatrizoate, ioxitalamate, metrizamide, ioxaglate, and a 22% sorbitol on aortic endothelia of the rat was performed. In each case 1 ml of the respective solution was injected in a single dose into the aorta. Endothelial damage was seen after injection of metrizamide, diatrizoate, and ioxitalamate. After injection of ioxaglate or sorbitol, only minor endothelial changes were observed.

[Monitoring studies of survivors of shock lung (ARDS). Correlation of radiology and lung function]. / Verlaufsbeobachtungen bei überlebter Schocklunge (ARDS). Korrelation von Radiologie und Lungenfunktion.

21 patients, who survived acute respiratory insufficiency following shock, are examined for residual pulmonary lesions. Retrospectively various parameters (f.e. blood gaz, radiological alterations) are analysed and correlated with results of a follow-up study (pulmonary function, chest films). Significant impairment of pulmonary functions could not be documented in a single patient. Roentgenologic late sequelae are seen only in two patients, which had a minor impairment of pulmonary function.

[Roentgen signs of rare mediastinal masses (author's transl)]. / Zur Röntgendiagnostik seltener Mediastinal "Tumoren".

Mediastinal masses are commonly classified into lesions of the anterior, middle, and posterior compartment as a first step in differential diagnosis. Teratoma, neurogenic tumors, goiters, and thymoma with their characteristic localization constitute together already two thirds of all mediastinal neoplasms. However, the differential diagnosis of mediastinal masses should include also rare diseases: lymphangio-hemangioma, aneurysm of the pulmonal artery, intrathoracic meningocele, esophageal cyst, and pleurobronchial cyst are demonstrated. It is emphasized, that differential diagnosis has to consider history and physical data of the patient as well.

[A chordoma of sacrococcygeal region as a cause of nephrotic syndrome (author's transl)]. / Nephrotisches Syndrom, verursacht durch ein lumbosakrales Chordom

A case of nephrotic syndrome connected with a chordoma of the sacrococcygeal region in a man aged 27 is described. Biopsy of the kidney revealed a diffuse membranous glomerulonephritis. Immunofluoresecenc showed deposits of IgG immunoglobulin on the basal membrane of glomeruli. In the patient's serum autoantibodies against chordoma cells were found. Those were also IgG globulins. To our knowledge such a relation of chordoma and nephrotic syndrome has not been described yet.