Anal squamous cell carcinoma in a patient with Peutz-Jeghers syndrome.
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Adult↗
Biomedical subjects
P Bauerfeind
Publications and source records attributed to P Bauerfeind.
Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults.
BACKGROUND & AIMS: In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence. METHODS: One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains. RESULTS: Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients. CONCLUSIONS: In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.
Adult↗
Is histological investigation of polyps always necessary?
BACKGROUND AND STUDY AIMS: To assess whether polyp histological type can be predicted by patient characteristics and endoscopic polyp findings. PATIENTS AND METHODS: 1681 polyps in 494 patients were categorized as advanced adenomas (villous component or severe dysplasia or early cancer) or insignificant polyps. Chi-squared tests were used to analyze whether polyp histological type could be predicted based on patient age (< 60 vs. > or = 60 years), gender, family history of colon polyps or cancer, presence of anemia, polyp size (< or = 5 mm vs. > 10 mm), and location (left- vs. right-sided). RESULTS: Insignificant polyp histology (n = 1337) correlated with patient age < 60 years (P = 0.0026), lack of anemia (P< 0.0001), polyp size < or = 5 mm (P < 0.0001), and right-sided location (P= 0.0058). Stepwise inclusion of these parameters demonstrated that the association of a < or = 5 mm right-sided polyp in a patient < 60 years yielded the highest combined predictive value (96.2%) for an insignificant polyp. Conversely, age > or = 60 years, presence of anemia, polyp size > 10 mm, or left-sided location, as single or combined parameters, demonstrated a maximum predictive value of only 75.4% for an advanced adenoma. CONCLUSIONS: A small right-sided polyp in a young patient is associated with a small risk (3.8 %) for advanced adenomatous tissue, indicating that histological investigation of such a polyp might not always be necessary. However, the recent recognition of flat adenomas and "mini" de novo colon carcinomas in the European population also may limit the usefulness of small polyp diameters in the exclusion of severe polyp histology.
Adenoma↗
Colon tumors and colonoscopy.
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Colonic Neoplasms↗
Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.
BACKGROUND: The aim of this study was to assess the efficacy of patient-controlled analgesia and sedation with propofol/alfentanil for colonoscopy compared with continuous drug infusion and conventional nurse-administered medication. METHODS: One hundred fifty patients undergoing colonoscopy on an outpatient basis were randomly assigned to 1 of 3 medication regimens. To maintain blinding, all patients were connected to an infusion pump. Group I patients could self-administer boluses of 4.8 mg propofol and 125 microg alfentanil without restriction. Group II patients received a continuous infusion with 0.048 mg/kg propofol and 0.12 microg/kg alfentanil per minute. Group III patients received intravenous premedication with 0.035 mg/kg midazolam and 0.35 mg/kg meperidine. RESULTS: There were no differences between the groups with respect to pain (visual analogue scale) and procedure time. Patient-controlled analgesia and sedation with propofol/alfentanil (group I) resulted in less of an increase in the transcutaneous partial pressure of carbon dioxide (p = 0.0004) during colonoscopy and less of a decrease in mean arterial blood pressure (p = 0.0021) during recovery, as well as more complete recovery (p = 0.0019) after 45 minutes compared with conventional administration of midazolam/meperidine. Furthermore, patient-controlled analgesia and sedation yielded a higher degree of patient satisfaction than continuous infusion of propofol/alfentanil (p = 0.0033) or nurse-administered midazolam/meperidine (p = 0.0094). CONCLUSIONS: Patient-controlled administration of propofol and alfentanil for colonoscopy may provide a better margin of safety than conventional administration of midazolam and meperidine and results in a higher level of patient satisfaction and shorter recovery.
Alfentanil↗
Favourable effect of an acidified milk (LC-1) on Helicobacter pylori gastritis in man.
OBJECTIVE: The supernatant of Lactobacillus johnsonii La1 culture was shown to be bactericidal and to have a partial, acid-independent suppressive effect on Helicobacter pylori in humans. The aim of the present study was to investigate the effect of L. johnsonii La1-acidified milk (LC-1) on H. pylori infection. DESIGN AND METHODS: Fifty-three volunteers infected with H. pylori as determined by positive 13C-urea breath test and positive serology were randomized to receive either LC-1 or a placebo 180 ml twice a day for 3 weeks. All subjects also received clarithromycin 500 mg bid during the last two weeks of acidified milk therapy. Oesophagogastroduodenoscopy and biopsies were performed at inclusion and repeated 4-8 weeks after the end of the treatment. H. pylori infection was confirmed by urease test and histology. H. pylori density and inflammation were scored using a modified Sydney classification. RESULTS: LC-1 ingestion induced a decrease in H. pylori density in the antrum (P= 0.02) and the corpus (P= 0.04). LC-1 also reduced inflammation and gastritis activity in the antrum (P= 0.02 and P= 0.01, respectively) and of activity in the corpus (P= 0.02). Clarithromycin eradicated H. pylori in 26% of the subjects; LC-1 did not improve the antibiotic effect. CONCLUSION: These results suggest that H. pylori infection and gastritis can be down-regulated by LC-1.
Animals↗
Expression of putative anticancer targets in familial adenomatous polyposis and its association with the APC mutation status.
Several substances interfering with colorectal carcinogenesis may reduce or prevent adenoma formation in familial adenomatous polyposis (FAP), an inherited predisposition to colorectal cancer. This study determined the expression of genes coding for putative anticancer targets (COX-2, iNOS, MMP-7, ODC, PKCbeta, PPARgamma, RXRalpha, RXRbeta, RXRgamma) in FAP patients to provide one of the rationales for the design of chemotherapy and -prevention strategies. Gene expression was assessed by TaqMan analysis in colonic tissue of 9 FAP patients with mutations in the APC gene (APCpos), 5 FAP patients without identified genetic defect (APCneg), and 3 healthy individuals. Among the examined genes, PKCbeta and MMP-7 were most consistently altered in adenoma tissue relative to matched mucosa. Intriguingly, ODC was clearly overexpressed in polyps from APCpos but not APCneg patients. Furthermore, PKCbeta, MMP-7, ODC, and COX-2 as well as all RXRs displayed altered expression in apparently healthy FAP mucosa as opposed to that of healthy individuals. Our data suggests PKCbeta and MMP-7 to be the most suited as anticancer targets among the genes studied.
Adenomatous Polyposis Coli↗
["Virtual colonoscopy": back to the future?].
"Virtual colonoscopy" is a new method of producing an endoscopic view of the colon without endoscopy. The images are derived from the data of conventional abdominal computer-tomography or magnetic resonance tomography, using modern computer programmes. The method makes it possible to detect colonic polyps or carcinomas with a sensitivity and specificity of 80%. The most interesting application of "virtual colonoscopy" may be as a screening method for colorectal polyps in preventing the development of colorectal cancer. This may improve patient acceptance for colorectal cancer screening programmes.
Colonic Neoplasms↗
Cost analysis of antibiotic prophylaxis for PEG.
BACKGROUND: There are conflicting recommendations regarding the prophylactic use of antibiotics in patients undergoing placement of percutaneous endoscopic gastrostomy tubes. The purpose of this decision analysis was to assess the cost-effectiveness of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. METHODS: A decision tree was modeled using the data of 7 published prospective placebo-controlled trials. Infectious complications were classified as grade I (requiring local care), grade II (requiring intravenous antibiotics), or grade III (requiring surgery). Medication costs were estimated from the United States average wholesale prices of the 1998 Red Book. Physician and facility costs were estimated based on the 1998 Medicare costs. A one-way sensitivity analysis was performed by varying the probability rates of the complications associated with percutaneous endoscopic gastrostomy and the costs of their treatment. RESULTS: The average cost of prophylactic antibiotics was $13.10. Antibiotic prophylaxis led to expected cost savings of $76.72 per percutaneous endoscopic gastrostomy. A sensitivity analysis suggested that antibiotic prophylaxis for percutaneous endoscopic gastrostomy was the preferred strategy unless the average probability of grade III complications dropped below an improbably low threshold value of 0.09%. CONCLUSION: Antibiotic prophylaxis in percutaneous endoscopic gastrostomy is a cost-effective strategy.
Antibiotic Prophylaxis↗
In-vivo real-time magnetic resonance monitoring of endoscopic laser applications in the porcine gastrointestinal tract.
BACKGROUND AND STUDY AIMS: Endoscopic laser therapy involves a risk of perforation, mainly because the depth of tissue destruction is not visible. Magnetic resonance (MR) imaging is capable of showing temperature changes, and is therefore suitable for monitoring thermal therapies such as laser. This animal study assessed the feasibility of real-time MR monitoring of endoscopic laser applications in the gastrointestinal tract. MATERIALS AND METHODS: The procedures were carried out using an MR-compatible endoscope in three live pigs in a 0.5-Tesla interventional MR system. Nd:YAG laser applications were performed in the lower gastrointestinal tract (n = 7) and upper gastrointestinal tract (n = 5), and were monitored using real-time color-coded T1-weighted gradient echo sequences. The postmortem macroscopic tissue coagulation sizes were compared with the lesion diameters seen on real-time MR. RESULTS: The endoscope did not cause any artifacts during continuous MR imaging. Ten of the twelve laser lesions were visible with temperature-sensitive MR imaging, and their sizes correlated well with the diameters of the postmortem macroscopic coagulation zones (r = 0.76, P = 0.009). Two laser lesions were not visible on MR due to technical limitations inherent with the healthy animal model. CONCLUSIONS: The formation of endoscopic laser lesions in the porcine gastrointestinal tract can be accurately visualized using real-time temperature-sensitive MR imaging. This new technique has the potential to spare healthy tissue while ensuring full treatment coverage of the targeted lesion with fewer therapy sessions.
Animals↗
Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients.
BACKGROUND: Nasoenteral feeding tube placement with the Seldinger technique using transoral endoscopy is a tedious procedure. This study compared the transoral approach with a new technique that uses a transnasal endoscope without the need for a mouth-to-nose wire transfer. METHODS: Critically ill patients requiring nasoenteral feeding tube placement were randomly assigned to the transoral technique using a standard upper endoscope (n = 80) or the transnasal method using a 5.3 mm fiberscope (n = 80). Procedure time, medication requirement, technical difficulty, patient tolerance, and radiologic tube position were assessed. RESULTS: The two groups were similar with regard to baseline medication, endoscopic findings, as well as overall technical difficulty and patient tolerance. The transnasal technique required less procedure time (median 8.0 versus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Furthermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.016) alterations regardless of the application of sedative or relaxant medication. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were significant in univariate hypothesis testing. Bonferroni correction for multiple testing of data removed the significance at p > 0.0031. Both techniques achieved similar rates of successful tube placement in the small bowel (86% versus 84%, p = 0.82). CONCLUSION: Transnasal endoscopy allows accurate placement of nasoenteral feeding tubes in critically ill patients and is superior to transoral endoscopy in terms of procedure time, medication requirement, and safety.
Adult↗
Colonic masses: detection with MR colonography.
PURPOSE: To assess magnetic resonance (MR) colonography as a method for detection of colorectal masses, with conventional colonoscopy as the reference standard. MATERIALS AND METHODS: MR colonography was performed in 132 patients referred for colonoscopy because of the possible presence of a mass. After rectal filling with a gadopentetate dimeglumine and water enema, T1-weighted three-dimensional gradient-echo MR studies were acquired with the patient in the prone and supine positions. Water-sensitive single-shot fast spin-echo MR images were also obtained. Surface-rendered virtual endoscopic endoluminal views, orthogonal sections in three planes, and water-sensitive MR images were interactively assessed for presence of colorectal masses by two radiologists. RESULTS: MR colonography was well tolerated without sedation or analgesia. MR image quality was sufficient for diagnosis in 127 (96%) patients. Most small (</=5-mm-diameter) masses were overlooked at MR colonography, but 19 of 31 6-10-mm lesions and 26 of 27 large (>10-mm) lesions were correctly identified. For these large masses, MR colonography had a sensitivity of 93%, specificity of 99%, positive predictive value of 92%, and negative predictive value of 98% for detection of masses. CONCLUSION: MR colonography is a promising modality for help in detecting colorectal mass lesions larger than 10 mm in diameter.
Administration, Rectal↗
PCR-positive tests for Tropheryma whippelii in patients without Whipple's disease.
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Actinobacteria↗
[New perspectives in 3D MR colonography].
Filling the colon lumen with contrast allows for 3D-MR-colonography. The 3D data set can be postprocessed to multiplanar reconstruction, surface shaded displays as well as virtual colonoscopy. The latter facilitates the differentiation between haustra and polyps and enables detection of polyps down to 6 mm in size. Multiplanar reconstructions provide the assessment of the inner wall contour. The morphology of the colonic wall itself can be assessed on T1- or T2-weighted images. T1-weighted sequences performed before and after i.v. contrast administration and T2-weighted sequences depict pathologies based on their contrast uptake respectively on their tissue water content. This concept of colonic imaging practicable in less than 15 minutes is useful for the assessment of inflammatory disease, for polyp detection as well as for tumour staging.
Colonic Diseases↗
Contrast optimization for assessment of the colonic wall and lumen in MR colonography.
This report focuses on the optimization of magnetic resonance colonography for combined virtual endoluminal and T2-weighted wall analysis of the colon and demonstrates the potential of the single-shot fast spin-echo (SSFSE) sequence for identifying colorectal pathologies. A 45 degrees flip angle in the three-dimensional spoiled gradient-echo sequence and a TE of 60 msec in the SSFSE sequence in conjunction with a 10 mM gadolinium concentration in the enema results in maximal contrast for the delineation of the colonic lumen in T1-weighted imaging and the colonic wall in T2-weighted imaging. The SSFSE sequence reveals hyperintense signal for inflammatory disease and most polyps exceeding 10 mm in size. It supplements the virtual endoluminal assessment by aiding in the differentiation between mass lesions and fecal matter or residual air.
Colon↗
Gastric pouch acid secretion in response to physiologic digestive function.
OBJECTIVES: To evaluate acid secretion and histologic features of the gastric segment used for bladder replacement in bladder cancer. METHODS: Nine patients were investigated a mean of 36 months after gastric pouch surgery with modified shamfeeding and feeding. We determined urinary acidity, urinary pH, serum gastrin, and serum pancreatic polypeptide values and tried to find a relationship between feeding and acid secretion in the gastric pouch. In 6 patients, biopsy and histopathologic examination were performed. RESULTS: In 8 patients, urinary acidity increased after feeding following the rise of gastrin; in 1 patient no increase of gastrin or acidity was observed. In 7 patients, urinary acidity did not change after modified shamfeeding, indicating vagal denervation after surgery. This group showed a minimal urinary pH of above 4 after feeding. On the other hand, in 2 patients an increased acid secretion was observed after modified shamfeeding, indicating the possible presence of residual vagal innervation. In this group, the acid secretion in the pouch was higher, reaching the minimal pH level earlier after feeding. Histopathologic examination showed no major structural changes of gastric mucosa. CONCLUSIONS: Most patients are vagally denervated after gastric pouch surgery, and the gastric segment continues its original gastrointestinal function by a hormonal pathway. Our data indicate, however, that in some patients, the gastric pouch keeps a residual vagal innervation. We therefore suggest that nerve fibers present in the blood supply of the gastric segment be interrupted to avoid the complications associated with increased acid secretion of the gastric pouch.
Aged↗
Virtual colonography.
Cross-sectional imaging techniques are increasingly being considered as alternative imaging modalities for colorectal screening. While CT-colonography uses air to insufflate the colon, an enema containing small amounts of paramagnetic contrast represents the basis for MR-colonography. Both techniques provide large three-dimensional data sets of the abdomen, containing the entire colon. Using sophisticated post-processing, the colon can be assessed in any desirable plane from various viewpoints. Thus even virtual endoscopic views can be rendered to assess the inside of the colon. This chapter briefly describes the technical aspects underlying both CT- and MR-colonography. Advantages and disadvantages of the two techniques are critically discussed, comparing them with one another as well as with conventional colonoscopy and barium enema.
Colonoscopy↗
Virtual colonoscopy in 1999: computed tomography or magnetic resonance imaging?
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Colonic Neoplasms↗