Double-balloon endoscopy versus magnet-imaging enhanced colonoscopy for difficult colonoscopies, a randomized study.

BACKGROUND AND STUDY AIMS: Studies have estimated that failure of cecal intubation occurs with conventional colonoscopy in up to 10 % of cases. Double-balloon endoscopy (DBE) systems, magnetic endoscope imaging (MEI), and transparent cap have been shown to improve success rates for colonoscopy. This study evaluated the utility of DBE for complete examination of the colon compared with MEI plus cap (MEI-Cap) after incomplete or technically difficult colonoscopy in a randomized comparative manner. PATIENTS AND METHODS: A total of 94 patients with incomplete or technically difficult colonoscopy were randomly assigned to receive either DBE (n = 47) or colonoscopy with MEI-Cap (n = 47). The primary end point was cecal intubation rate within 30 minutes. Secondary end points included intubation time, pain score using a visual analog scale, abdominal pressure attempts, doses of sedative medication, and changes in patient position during colonoscopy. RESULTS: Patient characteristics were comparable in both groups. Cecal intubation rate within 30 minutes was significantly higher for DBE (45 /47, 95.7 %) than for MEI-Cap (34 /47, 72.3 %) (P = 0.0049). Mean time to reach the cecum was significantly lower in the DBE group (13.0 ±â€Š5.3 minutes) than in the MEI-Cap group (16.4 ±â€Š4.8 minutes; P = 0.0003). No complications were encountered in either group.   CONCLUSION: DBE is more useful for complete examination of the colon than MEI-Cap in patients with incomplete or technically difficult colonoscopy.

[A case of miliary tuberculosis with intracranial tuberculoma].

A case of miliary tuberculosis with intracranial tuberculoma was reported. Homogenous or ring-like enhancing lesions surrounded with edema were seen after administration of contrast material on CT examination. However, CT is considered very useful method of evaluating the effect of antituberculous therapy.

[A case of T-cell type malignant lymphoma of the lung].

A case of T-cell type malignant lymphoma of the lung was reported. A 69-year-old woman was referred to our institute because of an abnormal shadow on the chest roentgenogram. She was symptom-free, and physical examination showed no abnormalities. Her laboratory tests were within normal limits. The chest roentgenogram showed a well-defined, nodular density in the left lower lung field without air bronchogram. She underwent a left lower lobectomy and a mediastinal lymphnodes dissection. This disclosed an elastic hard nodule, 2 cm in diameter, without pleural invasion. Pathologically the tumor was diagnosed as malignant lymphoma of T-cell type without regional lymphnode involvement. She is doing well without any sings of recurrence for one year after the operation.

[CT findings of malignant lymphoma of the anterior mediastinum--differentiation from invasive thymoma].

CT findings were compared retrospectively between 9 cases with malignant lymphoma of the anterior mediastinum and 8 cases with invasive thymoma. CT findings of malignant lymphoma were as follows: 1) The majority of the tumors were bilateral and extended beyond the anterior mediastinum to the other mediastinum compartments. 2) Their margin was either smooth or lobulated. 3) Their density was either homogeneous or heterogeneous. In the case with heterogeneous density, ring, triangle and/or band-like low density areas, just like interspace of fused lymph nodes, were demonstrated. Calcification or cysts could not be shown. 4) Patent inherent vessels without deviation were occasionally demonstrated running through the tumors. 5) The tumors faced and contacted widely to anterior chest wall and often pressed the lung laterally at the anterior parietomediastinal pleural reflection. 6) Pleural implants were not demonstrated.