The aim of this study was to compare the efficacy and patient tolerance of a new pulsed irrigation system to colonic lavage for colonoscopic preparation. Thirty-four prospective patients scheduled for routine colonoscopy were randomized to one of two preparations: a per-rectal pulsed irrigation device (18 patients) versus per-oral colonic lavage (15 patients). Colonoscopic preparation was assessed on a 0 to 4 plus scale by region and overall. This was done live and by video tape by two independent endoscopists who were blinded to the patient's preparation. There was no significant difference with respect to cleanliness of the colon with pulsed irrigation patients having an average overall preparation score of 3.00 +/- 0.19 (SEM) versus colonic lavage patients with a score of 3.14 +/- 0.19. There was also no statistically significant difference between the two groups with respect to demographics, time to reach the cecum, time for entire procedure, volume of aspiration or wash, or sedation given. We conclude that the new pulsed irrigation device provides an alternative to the standard per-oral lavage solution for colonoscopic preparation.

Administration, Oral↗

PubMedDate not supplied

Clinical utility of endoscopic ultrasound-guided fine needle aspiration.

OBJECTIVE: To assess our institution's initial experience with the clinical utility of endoscopic ultrasound (EUS)-guided fine needle aspiration. STUDY DESIGN: Prospective analysis of the clinical utility of EUS-guided FNA. RESULTS: Fifty-three patients underwent EUS-guided FNA of 64 sites, 28 for pancreatic masses, 15 for lymph nodes, 10 for solid lesions, 7 for cystic masses, 2 for submucosal masses and 2 for perigastrointestinal fluid. A cytopathologist was present during all procedures. An average of four passes (range, one to nine) was required to make a diagnosis in the 22 patients with pancreatic malignancies. There was one possible complication among the 53 patients. In 36 of the 53 patients, the combination of diagnostic EUS findings and cytologic diagnosis made a major change in the patient's management. CONCLUSION: Because of its ability to affect patient management, EUS-guided FNA will become a more commonly used procedure, especially at oncologic centers. Since the number of fine needle passes needed for diagnosis is quite variable, it is important to have a cytopathologist participate in these procedures.

Abdominal Neoplasms↗

PubMedDate not supplied

An assessment of the effect of "DOC talk" on school children in rural Iowa.

The effectiveness of family physicians as health educators through a community health organization (Doctors Ought To Care/DOC) was studied. Seventh-grade students in a rural school system received a series of uniquely prepared slide presentations (DOC talks) on smoking, alcohol, drug use, and venereal disease to study the effect of such talks on knowledge gain and behavior change. The presentations were made during the semester in which the students were also taking a required health education course. A second group of seventh graders in the same school system did not receive the presentations but had the same health education course and served as the control group. Both groups showed similar gains in knowledge during their semester of health education. However, only the group which received the DOC talks showed a continuation of knowledge gains on a follow-up questionnaire. Also, only the group which saw the presentations showed positive behavior changes including decreased substance use. While aware of the study's methodologic limitations, we believe the results support the value of the community physician presenting DOC talks to supplement the usual school health curriculum.

Adolescent↗

PubMedDate not supplied

Endoscopic ultrasound-guided fine-needle aspiration.

Thirty-eight consecutive patients underwent endoscopic ultrasound-guided fine-needle aspiration. Of 46 lesions, 34 were extraluminal (12 pancreatic masses, 8 periesophageal nodes, 6 celiac nodes, 2 pericolonic masses, 1 mediastinal mass, 1 perigastric mass, 1 liver, 1 periduodenal node, 1 perirectal mass, 1 perirectal node) and 12 were submucosal (8 gastric, 3 duodenal, 1 esophageal). One hundred sixty-three passes were made, with an average of 3.5 passes per lesion and 4.3 passes per patient (range, 1 to 8). Adequate specimens were obtained from 91% of targeted lesions. The overall diagnostic accuracy was 87%. In patients with malignant lesions, sensitivity was 91% and specificity 100%. Celiac nodes were successfully sampled and diagnostic in 5 of 6 (83%) patients. No complications occurred. Using this technique, an initial tissue diagnosis of malignancy was made in 66% of cancer patients without a previous diagnosis and the preoperative stage was changed in 44% of cancer patients. The additional information gained by this modality directly influenced the decision not to perform surgery in 26% of patients with a primary malignancy. Endoscopic ultrasound-guided fine-needle aspiration is feasible and can be safely used to evaluate submucosal and extraluminal lesions in both the upper and lower gastrointestinal tract with a high degree of diagnostic accuracy.

Adult↗