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PubMedDate not supplied

Resting and dobutamine stress echocardiographic factors associated with the development of occult dilated cardiomyopathy in healthy Doberman pinscher dogs.

In 29 healthy Doberman Pinschers, echocardiographic parameters evaluating systolic and diastolic function were examined prospectively at rest and during dobutamine constant rate infusion (5 micrograms/kg/minute) to determine if any parameters were associated with the development of occult dilated cardiomyopathy (DCM). A resting echocardiogram was repeated 1 year later to determine which dogs had met our criteria for occult DCM. Six dogs developed occult DCM during the follow-up period. Univariate logistic regression analysis showed that at rest, an increased left ventricular internal dimension in systole (LVID-S) (P = .02), preejection period (PEP) (P = .03), ratio of PEP to left ventricular ejection time (P = .02), and isovolumic relaxation time (P = .02) were significantly associated with the development of occult DCM. During dobutamine stress echocardiography (DSE), high LVID-S (P = .02) and systolic wall stress index (P = .04) and reduced fractional shortening (P = .02) and ratio of peak early to late diastolic mitral filling velocity (E/A) (P = .05) were associated with the development of occult DCM. Multiple logistic regression showed that LVID-S (P = .002) and E/A (P = .002) measured during dobutamine infusion also were associated with the development of occult DCM. Reclassification based on the DSE data was not significantly different than reclassification based on the resting echocardiographic data. Resting echocardiography and DSE have the potential to be clinically applicable screening tests for very early systolic and diastolic dysfunction in Doberman Pinschers, heralding the onset of occult DCM as it is currently defined.

Animals↗
PubMed2000

Clinicopathological correlation in exudative age related macular degeneration: histological differentiation between classic and occult choroidal neovascularisation.

AIMS: To analyse the histopathology of classic and occult choroidal neovascular membrane surgical specimens in age related macular degeneration. METHODS: 35 membranes, from a consecutive series of surgically removed choroidal neovascular membranes in age related macular degeneration, were classified as classic or occult following the guidelines of the Macular Photocoagulation Study. Membranes with classic as well as occult components were considered as mixed membranes. The membranes were serially sectioned and stained with haematoxylin and eosin, Masson trichrome, periodic acid-Schiff, and phosphotungstic acid haematoxylin stain. The correlation has been made in a masked fashion. RESULTS: 31 membranes (19 classic, 10 occult, and two mixed membranes) could be analysed histologically. 18 classic choroidal neovascular membranes had a major subretinal fibrovascular component and 10 of these had an additional, minor fibrovascular component under the retinal pigment epithelium. The 10 occult membranes contained a fibrovascular component under the retinal pigment epithelium and the two mixed membranes contained fibrovascular tissue on both sides of the retinal pigment epithelium. Fibrin and remains of outer segments tended to occur at the lateral edges of classic membranes and to cover the inner surface of occult membranes. CONCLUSION: Classic choroidal neovascularisation in age related macular degeneration is predominantly composed of subretinal fibrovascular tissue while occult choroidal neovascularisation is composed of fibrovascular tissue at the choroidal side of the retinal pigment epithelium.

Aged↗
PubMed1998

Indocyanine green angiography in age-related macular degeneration with occult neovascularization.

This study has been conducted to assess the sensitivity of indocyanine green angiography (ICGA) in detecting choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD) with occult CNV at fluorescein angiography (FA) and to establish their eligibility for laser photocoagulation. Three hundred eighty-three eyes of 355 consecutive patients with occult CNV at FA were studied by ICGA; occult CNV with or without pigment epithelial detachment (PED) were detected as well. Eligibility for laser treatment was established on the basis of the ICGA-guided CNV extension and localization. Out of 157 eyes (41%) with occult CNV and PED, 74 (47.1%) showed focal ICGA CNV, 35 eyes (22.3%) had plaque CNV. Thirty-five eyes with PED (22.3%) appeared serous without CNV, and in 13 eyes (8.3%) no CNV was detectable because of large hemorrhages. Out of the 226 eyes (59%) presenting occult CNV without PED, 94 eyes (41.6%) had plaque CNV, and 58 (25.7%) had focal CNV. In 74 eyes (32.7%), there was no detectable CNV or only an ill-defined ICGA appearance. ARMD with PED is closely associated with focal CNV, while plaque CNV is largely found in exudative ARMD without PED (p < 0.001). Considering all the cases examined by ICGA, CNV was evident in 261 eyes (68%) occult at FA. Extrafoveal CNV laser treatment was recommended for 103 eyes (27%). Our results suggest that ICGA may be useful in the diagnosis and management of ARMD with occult CNV at FA increasing the number of patients eligible for laser treatment.

Aged↗
PubMed2000

Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome.

OBJECTIVE: To evaluate selected characteristics of occult bacteremia in the post-Haemophilus influenzae type b (HIB) vaccine era. METHODS: A retrospective cohort study was performed involving 5901 children 2 to 24 months old with fever >/=39.0 degrees C evaluated with a blood culture at an urban tertiary care children's hospital emergency department (ED) between February 1993 and June 1996. Patients were excluded if immune-suppressed, diagnosed with a focal infection, evaluated by lumbar puncture, or admitted to the hospital during initial evaluation. Prevalence of occult bacteremia, distribution of current pathogenic organisms, and time to positive culture in a continuously monitored system were determined. All patients with cultures positive for pathogenic bacteria were reevaluated and serious adverse outcomes were documented. RESULTS: The prevalence of occult bacteremia was 1.9% (95% confidence interval: 1.5%-2.3%). Streptococcus pneumoniae accounted for 82.9% of all pathogens and H influenzae was not a causative organism in this cohort. The mean time to positive culture was significantly shorter for pathogens compared with contaminants (14.9 hours vs 31.1 hours). A culture that was positive in </=18 hours was 13.0 (6.3-26. 6) times more likely to contain a pathogen than a contaminant. The average time from positive culture notification to reevaluation in the ED was 10.6 hours and over half of the patients recalled to the ED for positive cultures were admitted to the hospital. Of patients with occult pneumococcal bacteremia, 95.7% had resolution of their bacteremia without the use of parenteral antibiotics. Two patients had serious adverse outcomes. The rate of meningitis or death was. 03% (.004%-.12%). The contamination rate of blood cultures was 2.1% (1.7%-2.5%). Most (85%) of these patients were reevaluated in the ED and more than one third were admitted to the hospital before full identification of the organism. CONCLUSIONS: Prevalence of occult bacteremia in the post-HIB vaccine era is lower than previously reported. S pneumoniae is the most common causative organism and resolves without parenteral antibiotics in the vast majority of cases. Continuously monitoring blood culture systems allow for early identification and can aid in differentiating contaminated from true pathogenic cultures by time to positive culture. Serious adverse outcome is an uncommon result of occult bacteremia. Updated epidemiology and microbiologic technology may impact the evaluation and treatment of children at risk for occult bacteremia.

Bacteremia↗
PubMed1992

Occult glove perforations: frequency during interventional radiologic procedures.

Because the intact surgical glove is an important barrier against exposure to blood and other body fluids, occult glove perforations occurring during procedures may have implications for infection control and protection of health care workers. Although the frequency of occult glove perforations during surgery has been studied, no such data have been reported for interventional radiology. This study was designed to determine the frequency of occult glove perforations in interventional radiology. Gloves used during interventional radiologic procedures were collected and tested for occult perforations according to previously accepted methods. The frequency of occult defects in unused gloves was also determined. A form completed for each pair of gloves indicated length of use, awareness of perforations, and information about the procedure. The anatomic distribution of perforations was also studied. Occult perforations were found in 49 (10%) of 492 used gloves. The frequency of defects in unused gloves was 1% (2/160). Gloves worn fewer than 2 hr had a perforation rate of 7% (29/406), and those worn 2 hr or longer had a rate of 23% (20/86; p less than .0001). Perforations were noticed by the wearer in only three (6%) of the 49 perforations. The perforation rate for inner gloves of a double-glove set was 3% (1/34; the corresponding outer glove also was perforated). Although the 10% rate of occult glove perforation during interventional radiologic procedures found in this series is lower than rates described with surgical procedures, it is not insignificant. The significant increase in the rate of perforation when gloves are worn more than 2 hr suggests that gloves should routinely be changed at or before 2 hr of wear, particularly in procedures involving high-risk patients.

Equipment Failure↗
PubMed2007

Prospective screening for occult cardiomyopathy in dogs by measurement of plasma atrial natriuretic peptide, B-type natriuretic peptide, and cardiac troponin-I concentrations.

OBJECTIVE: To evaluate the use of measuring plasma concentrations of atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and cardiac troponin-I (cTnI) to detect dogs with occult dilated cardiomyopathy (DCM). ANIMALS: 118 client-owned dogs. PROCEDURES: Dogs were prospectively examined by use of ECG; echocardiography; and evaluation of concentrations of ANP, BNP, and cTnI. Occult DCM was diagnosed by evaluation of echocardiographic left ventricular dimensions and detection of ventricular arrhythmias on ECG. Sensitivity and specificity of assays for measurement of plasma concentrations of ANP, BNP, and cTnI to detect dogs with occult DCM were determined. RESULTS: Occult DCM was diagnosed in 21 dogs. A concentration of > 6.21 pg/mL for BNP had a sensitivity of 95.2% and specificity of 61.9% for identifying dogs with occult DCM. In contrast, concentrations of ANP and cTnI had relatively low predictive values. CONCLUSIONS AND CLINICAL RELEVANCE: Blood-based screening for occult DCM in dogs can be accomplished by use of a BNP assay. Additional studies should be performed to optimize this method of screening dogs to detect occult DCM.

Animals↗
PubMedDate not supplied

Pre-eruptive intracoronal resorption as an entity of occult caries.

"Occult" or "hidden" caries refers to occlusal caries which is not diagnosed clinically because the occlusal surface appears ostensibly intact, and radiographs show radiolucencies in dentin. The prevalence of occult caries has been reported to range from 2.2% to over 50% of permanent molars. In spite of its relatively high prevalence, the etiology and pathogenesis of occult caries remain unclear. The author hypothesizes that occult lesions could have resulted from processes which are pre-eruptive or post-eruptive. Pre-eruptive processes include intracoronal resorption of unerupted teeth, and the post-eruptive process is occlusal fissure caries. Although the prevalence of intracoronal resorption has been shown to be around 3-6% by subject and 0.5-2% by teeth, the percentage contribution of this process to the overall prevalence of occult caries is unclear. When affected teeth are fully erupted, it is difficult to determine if pre-eruptive resorption had been present previously. The prevalence of occult lesions does not appear to be affected by fluoride exposure. Radiographs are useful adjuncts to aid in the diagnosis of occult lesions. Bitewing radiographs are useful for detecting early occlusal fissure caries while panorex radiographs of unerupted developing teeth aid in the diagnosis of pre-eruptive intracoronal lesions. It is suggested that all unerupted, developing teeth on radiographs be examined for pre-eruptive resorptive lesions.

Adolescent↗
PubMed2003

Lymph node occult micrometastasis in patients with non-small cell lung carcinoma: genetic diagnosis and its impact on prognosis.

BACKGROUND & OBJECTIVE: Occult micrometastasis to mediastinal lymph node, which could not be detected by routinely histopathologic examination, might be correlated with the prognosis of patients with non-small cell lung carcinoma (NSCLC). The aim of this stud y was to diagnose occult micrometastasis of mediastinal lymph node in NSCLC patients and evaluate its prognostic significance. METHODS: Using reverse transcription-polymerase chain reaction (RT-PCR), 242 stations of mediastinal lymph nodes, which were free of tumor determined by histopathologic examination(pN0), from 58 patients were examined for MUC1 gene mRNA and to diagnose occult micrometastasis. All the patients were followed-up for three years. The survival rate was calculated by Kaplan-Meier method and the survival was compared with log-rank test between the patients with and without occult nodal micrometastasis. RESULTS: The MUC1 gene mRNA was identified in 23 stations of lymph nodes from 16 patients, and nodal occult micrometastasis was diagnosed in the 27.6% of the patients. TNM staging for these patients was up-regulated from stageI(A)-II(B) to stage III(A). The 3-year survival rate in the patients with nodal occult micrometastasis (43.7%) was lower than that in the patients without nodal occult micrometastasis (73.8%) (P< 0.05). CONCLUSION: The expression of MUC1 gene mRNA in mediastinal lymph node is associated with poor prognosis of NSCLC patients with pN0 disease, suggesting that it may be an indicator of poor prognosis.

Adult↗
PubMedDate not supplied

Occult metastases in the axillary lymph nodes of patients with breast cancer node negative by clinical and histologic examination and conventional histology.

We examined axillary lymph nodes from 80 women with node-negative breast cancer, by immunohistochemistry, utilizing polyclonal antibodies to cytokeratins and carcino-embryonic antigen and monoclonal antibodies to cytokeratins and milk fat globulin. Occult metastatic tumor, undetectable in hematoxylin and eosin stained slides, but visible by immunohistochemistry, was detected in 23 of 80 patients (29 per cent). Occult tumor was observed in patients with invasive ductal carcinoma (21/76-28 per cent) and in individuals with invasive lobular carcinoma (2/4-50 per cent). In patients with occult metastases the primary tumors were slightly larger (mean 2.39 cm, range 1.00-5.00 cm) than those of patients whose nodes were negative for tumor cells (mean, 2.03 cm, range, 0.60-4.50 cm). Information concerning clinical outcome is available for 61 patients followed for between 1 and 7 years (mean 3.2 years). Three of 17 patients (18 per cent) who had occult tumor in the nodes developed distant metastases, all less than 3 years after initial surgery. One of the 44 patients (2 per cent) whose nodes were free of occult tumor developed distant metastases 5 years following surgery. Local recurrences in the area of the mastectomy occurred in one of 17 patients with occult nodal tumor (6 per cent), less than 1 year after surgery. Local recurrences were seen in three of 44 patients without occult metastases (7 per cent), in two patients 5 years after mastectomy and in one patient 7 years after mastectomy.

Adult↗
PubMed1991

[The effects of pregnancy on prolactin secretion in occulted hyperprolactinemia].

The changes in the maternal prolactin level during pregnancy and puerperium were studied in 14 patients with occulted hyperprolactinemia, 5 patients with functional hyperprolactinemia, and 135 women with normoprolactinemia. All of those with occulted hyperprolactinemia and functional hyperprolactinemia became pregnant through bromocriptine treatment. Higher prolactin levels were noted in occulted hyperprolactinemic patients from the first to second trimester of pregnancy, but in the third trimester prolactin levels fell to the normal control levels. This change completely resembled the change in functional hyperprolactinemic patients. Prolactin secreting capacities after puerperium returned to normal in 4 of the 5 patients with occulted hyperprolactinemia. These 4 became pregnant for the second time without any treatment. However, the other patient, whose prolactin secreting capacity was aggravated after the first puerperium, became pregnant the second time through bromocriptine treatment. These results indicate the following: 1) most cases of occulted hyperprolctinemia which may be due to functional lesions return to normal after pregnancy, 2) in rare cases of occulted hyperprolactinemia, prolactin secretion capacity is aggravated after the pregnancy, 3) it is important to observe the natural history of the patient in the treatment of occulted hyperprolactinemia.

Bromocriptine↗
PubMed1987

The relative value of fecal occult blood tests and flexible sigmoidoscopy in screening for large bowel neoplasia.

The secondary prevention of colorectal cancer is based on the early detection of noninvasive cancer and removal of adenomatous polyps. The two commonly used screening tests are flexible sigmoidoscopy and guaiac fecal occult blood testing. Both were performed simultaneously and independently on 1176 asymptomatic volunteers followed by colonoscopic examination if either occult blood or a neoplasm was detected. Neoplasia (adenomatous polyps or cancer) were found in 48 screenees. Only ten had positive stool occult blood while 45 were detected by sigmoidoscopy. Analysis of sensitivity for neoplasia was 93.8% for sigmoidoscopy but only 20.8% for the occult blood tests, while the positive predictive values for neoplasia were 100% and 23.8% respectively. The fecal occult blood test detected only 18% of screenees with adenomas and 60% with invasive cancer. Flexible sigmoidoscopy detected 95% and 80% respectively. Analysis (kappa statistic) demonstrated little agreement between the two tests (P greater than 0.05), indicating that they are diagnosing different neoplasia. Evaluation of expected gain in diagnosing neoplasia, by combining both tests, gave 18% for the fecal blood test and 94% for the endoscopic test. These results confirm the complementary value of performing both tests, but especially the high sensitivity and predictive value positive of flexible sigmoidoscopy for adenomas, including those with severe dysplasia, and the converse for the fecal occult blood test. This latter test must be recommended and used within a screening program with caution and full understanding of its limitations.

Adult↗
PubMed2000

Faecal occult blood in children with coeliac disease.

UNLABELLED: It has recently been suggested that in adults with coeliac disease, faecal blood loss may play a role in the development of iron deficiency. A group of 45 children diagnosed with coeliac disease during 1996 and 1997 were therefore prospectively evaluated for the presence of gluten in their diet, iron deficiency anaemia, and faecal occult blood. Sixty children admitted for elective surgery or asthma served as controls. Faecal occult blood was found in four iron deficient children on normal diet, of whom three were newly diagnosed. Occult blood loss disappeared in three of the four children when gluten was removed from their diet. Faecal occult blood was found in 26.7% of children on gluten-containing diet, but not in children on gluten-free diet (P = 0.01), or in control children (P = 0.001). CONCLUSION: Our data suggest that the incidence of occult blood loss in coeliac disease occurs mainly in newly diagnosed cases and responds to a gluten-free diet. Occult blood testing may not be warranted in the absence of iron deficiency anaemia nor in children with iron deficiency anaemia who are on a gluten-free diet.

Adolescent↗
PubMed2004

Digital rectal fecal occult blood screening during gynecologic examination.

OBJECTIVE: The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination. STUDY DESIGN: We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination. RESULTS: Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer. CONCLUSION: Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results.

Aged↗
PubMed2005

Occult bleeding in three different antithrombotic regimes after myocardial infarction. A WARIS-II subgroup analysis.

INTRODUCTION: Warfarin, aspirin, and the combination of these, have all proven to be efficacious in preventing future events after myocardial infarction. The accompanying bleeding tendency is a concern. The aim of the present study was to compare the occurrence of occult bleeding and iron deficiency during these treatment modalities. METHODS: The 267 patients who had survived a myocardial infarction were randomly assigned in the Warfarin Aspirin Reinfarction Study to treatment with aspirin 160 mg/day, or warfarin (INR 2.8-4.2), or aspirin 75 mg/day plus warfarin (INR 2.0-2.5). The patients were screened for the occurrence of occult bleeding in faeces and urine after 3 months. Haemoglobin and iron metabolism parameters were measured at baseline, after 3 months, and at the end of the 4 years follow-up. RESULTS: The number of occult bleeding in faeces was 19 (7.1%) and in urine 29 (10.9%). There were no intergroup differences (p=0.45 and 0.39, respectively). In the occult bleeders, a second test showed 3 (1.1%) positive samples in faeces and 9 (3.4%) in urine. Further investigation revealed 2 cases of malignant disease. Haemoglobin and iron status variables were all within normal limits after 3 months and after 4 years in all treatment groups. CONCLUSIONS: Long-term treatment with aspirin, warfarin, or both, in the present doses and levels of anticoagulation did not lead to anemia or iron deficiency. The occurrence of occult bleeding in faeces and urine was a temporary phenomenon in most patients. Only macroscopic bleedings during these treatment modalities were of clinical importance, and screening for occult bleeding was of limit value.

Anticoagulants↗
PubMed1999

Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy?

PURPOSE: There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy. SUBJECTS AND METHODS: All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed. RESULTS: During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001). CONCLUSIONS: Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia.

Aged↗
PubMed1998

Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests.

BACKGROUND: Although bleeding lesions anywhere in the gastrointestinal tract can cause a positive reaction on guaiac-based fecal occult-blood tests, the relative frequency of upper gastrointestinal and colonic lesions is unknown. METHODS: During a period of 30 months, we prospectively studied all patients with at least one stool specimen containing fecal occult blood who were referred for further evaluation. Fecal occult blood was detected by standard guaiac-based tests of stool specimens obtained as part of routine screening or of stool obtained by digital rectal examination. Patients with documented iron-deficiency anemia or active gastrointestinal bleeding were excluded from the study. All participants had a detailed history taken and underwent colonoscopy, followed by esophagogastroduodenoscopy. RESULTS: Of the 409 patients with fecal occult blood who were referred, 310 were potentially eligible to participate, and 248 (mean age, 61 years; range, 40 to 89) were studied; 40 percent were women. We identified lesions consistent with occult bleeding in 119 patients (48 percent); in 71 bleeding lesions were found in the upper gastrointestinal tract, and in 54 they were identified in the colon. Six patients had abnormalities in both areas. The most common upper gastrointestinal lesions were esophagitis (23 patients), gastric ulcer (14), gastritis (12), and duodenal ulcer (10). Thirty patients with lesions in the upper gastrointestinal tract were long-term users of aspirin, ethanol, nonsteroidal antiinflammatory drugs, or a combination of these substances. The most common colonic lesions were adenomas more than 1.0 cm in diameter (29 patients), carcinoma (13), colitis (5), and vascular ectasia (5). Although the overall sensitivity of symptoms for the detection of gastrointestinal lesions was low, logistic-regression analysis demonstrated that the presence of symptoms in the upper gastrointestinal tract was associated with the detection of lesions in the upper gastrointestinal tract (odds ratio, 2.6; 95 percent confidence interval, 1.4 to 4.7). In both patients with symptoms and those without symptoms, the prevalence of lesions in the upper gastrointestinal tract was greater than or equal to that of colonic lesions. CONCLUSIONS: In a group of patients with positive fecal occult-blood tests who were referred for further evaluation, from which those with iron-deficiency anemia and active bleeding had been excluded, upper gastrointestinal lesions were identified more frequently than colonic lesions.

Aged↗
PubMed1987

Evaluation of an immunochemical test for faecal occult blood in screening for colorectal neoplasia in a high risk group.

A group of 1615 asymptomatic individuals presumed to be at increased risk of colorectal neoplasia were selected as the study group. All were tested by an immunochemical test for faecal occult blood. In the second half of the study, individuals who were occult blood negative were offered colonoscopy. Ninety-nine individuals (6.1%) returned stools which were occult blood positive. Investigation by full colonoscopy was possible in 90 cases, revealing nine patients (10%) with invasive cancers, four patients (4.4%) with carcinomata in situ, and 36 patients (40%) with adenomata. Non-neoplastic pathology capable of producing occult blood positive stools was found in 31 individuals (34.4%). No pathology was found in 10 instances (11.1%). Of the 53 occult blood negative subjects who underwent colonoscopy, eight were found to have adenomata. Only one of these was larger than 5 mm in diameter (18 mm). No carcinomata were found. The site within the large bowel of the tumour did not appear to significantly affect the occult blood status of the faeces but the size of the tumours detected suggests that the presence of blood within the stool is more likely to be associated with larger lesions. The frequency of detection of both carcinomata and adenomata was greatest in individuals who had a past history of colorectal neoplasia. The individual cost of this immunochemical test is nominal. The high diagnostic yield and low false positive and negative rates suggest that case follow-up, surveillance, or screening utilizing this test is justified.

Adult↗
PubMed2000

Survey of internal medicine residents' use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance.

OBJECTIVE: Primary care physicians have imperfect understanding of current colorectal cancer screening guidelines and recommendations. Furthermore, compliance with colorectal cancer screening by internal medicine residents has been demonstrated to be poor. We sought to identify whether current trainees in internal medicine had adequate understanding of colorectal cancer screening and surveillance and test utilization. METHODS: We applied a structured questionnaire about colorectal cancer screening and the use of fecal occult blood tests to 168 internal medicine residents at four accredited programs in the U.S. They were also asked for recommendations about six hypothetical patients who may have been candidates for screening or surveillance. RESULTS: Seventy-one percent identified 50 yr as the currently recommended age to commence screening in an average-risk individual; 64.3% would begin screening with fecal occult blood testing and flexible sigmoidoscopy and 4.8% with colonoscopy. Most perform fecal occult blood testing on stool obtained at digital rectal exam and without prior dietary restrictions. Many use fecal occult blood testing for indications other than colorectal cancer screening. Only 29% recommended colonoscopy to evaluate a positive fecal occult blood test. Most residents plan to be screened for colorectal neoplasia at the appropriate age; significantly more opted for colonoscopy than recommended it for their patients. CONCLUSIONS: Internal medicine residents have many misperceptions regarding colorectal cancer screening and the utility of the fecal occult blood test. Educational efforts should be directed at internal medicine residents, many of whom plan careers in primary care, where most colorectal cancer screening is currently performed.

Adult↗