RESUMO
Re-usable air/water and suction valves used in endoscopes often demonstrate risk of infection. To the authors' knowledge, the safety and efficacy of re-usable and single-use valves have not been compared to date. As such, a laboratory investigation was undertaken to compare the safety and efficacy of re-usable and single-use valves at 11 Italian endoscopy sites. Safety was evaluated by analysing the rinse liquid of reprocessed re-usable valves ready for use, and efficacy was assessed based on the completion of endoscopic procedures without valve malfunction. This study found significantly lower contamination of single-use valves compared with re-usable valves (0 vs 29.1%, respectively; P=0.007) and similar efficacy (97.6 vs 98.8%, respectively; P=ns). Microbiological analysis of the rinse liquid of reprocessed re-usable valves identified various surviving micro-organisms and highlighted their potential pathogenicity. Such data suggest that sterile single-use valves may be safer than re-usable valves, and have comparable performance.
RESUMO
OBJECTIVE: To investigate the efficacy and tolerability of octatropine methyl bromide plus diazepam (Valpinax) in patients with irritable bowel syndrome (IBS). MATERIALS AND METHODS: We conducted a randomized, double-blind, multicentre study in 186 patients aged 18-65 years with IBS diagnosed according to Rome II criteria. Following a 2-week washout period, patients received octatropine plus diazepam 40 mg/2.5 mg twice daily or placebo for 6 weeks. The primary efficacy endpoint was response to a weekly question: "did you have satisfactory relief of your abdominal pain and discomfort during the last week?" Other endpoints included abdominal swelling, abdominal pain and discomfort, symptom severity, and the number of bowel movements. A prespecified subgroup analysis was conducted in patients with an abdominal pain and discomfort score > or = 3. RESULTS: The primary efficacy endpoint showed a tendency towards a statistically significant benefit for octatropine plus diazepam over placebo among patients with a baseline abdominal pain and discomfort score of > or = 3 (3 vs. 0 patients; p = 0.059). Octatropine plus diazepam demonstrated significant improvements from baseline in all parameters assessed, but not compared with placebo. Adverse events were reported in 15.1% of patients receiving octatropine plus diazepam. CONCLUSIONS: Patients with IBS and an abdominal pain and discomfort score of > or = 3, who may be considered in the active phase of the disease, may derive some benefits from octatropine plus diazepam. This study highlights that Rome II criteria should be considered with particular care in the design of a clinical trial, since it does not consider disease activity level on admission.
Assuntos
Diazepam/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Síndrome do Intestino Irritável/tratamento farmacológico , Tropanos/uso terapêutico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Defecação/efeitos dos fármacos , Diazepam/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Fármacos Gastrointestinais/efeitos adversos , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Medição da Dor , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Tropanos/efeitos adversos , Adulto JovemAssuntos
Doença Imunoproliferativa do Intestino Delgado/diagnóstico por imagem , Adolescente , Humanos , Imunoglobulina A/metabolismo , Doença Imunoproliferativa do Intestino Delgado/complicações , Doença Imunoproliferativa do Intestino Delgado/imunologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Coeliac disease is a primary malabsorption syndrome, whose gastrointestinal symptomatology regresses following a gluten-free diet. Several authors report an increased incidence of intestinal lymphoma in patients with longstanding coeliac disease; on the other hand the association of this malabsorption syndrome with malignant tumors of the esophagus, stomach or large bowel is not very common. The authors describe three cases of coeliac disease complicated after 5, 12 and 18 years by neoplasms of the esophagus, stomach and small bowel. It is stressed that in this disease patients must be monitored with periodic radiologic examinations, in the hope of detecting any malignancy at an early and perhaps treatable stage.
Assuntos
Doença Celíaca/complicações , Neoplasias Esofágicas/etiologia , Neoplasias do Íleo/etiologia , Neoplasias do Jejuno/etiologia , Neoplasias Gástricas/etiologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/etiologia , Adulto , Neoplasias Esofágicas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Linfoma/etiologia , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias Gástricas/diagnóstico por imagemRESUMO
Our study was directed not only towards the diagnosis of small bowel Crohn's disease, but especially to a quantitative analysis, for a correct therapeutical approach. This experimental trial is based on the relationship between radiological evidence, measured during small bowel enema, and the seriousness of the morphological and functional damage to the intestinal mucosal membrane, evaluated with a post-heparin diamine-oxidase activity test. With this method we studied 35 selected patients; 16 of them were affected by the disease with an exclusive localization in the small bowel and 5 have been considered separately, because 3 patients had already been operated and the other 2 showed different localizations. In our results, the two parameters were not constantly related to each other. In other words the enema's morphological data sometimes do not accord with the mucosal membrane integrity index expressed by the enzyme. Anyway the importance of this study is the attempt of making an objective comparison between an anatomic situation and its functional consequence. These aspects have a great significance in Crohn's disease.
Assuntos
Amina Oxidase (contendo Cobre)/sangue , Doença de Crohn , Intestino Delgado/diagnóstico por imagem , Sulfato de Bário , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/enzimologia , Humanos , Metilcelulose , RadiografiaRESUMO
Malabsorption syndrome is a clinical condition that can be determined by several situations which can ensue by many etiopathogenetic mechanisms. While the diagnostic approach is, for this reason, complex and uses a lot of clinical, laboratory and instrumental techniques, the therapeutic approach could be surgical or medical. The aim of our research is to establish the diagnostic utility of the radiologic examination of the small intestine by enteroclysis, on the basis of our personal experience and the data referred in literature. We took particular care of the radiological study of primitive malabsorption.
Assuntos
Intestino Delgado/diagnóstico por imagem , Síndromes de Malabsorção/diagnóstico por imagem , Sulfato de Bário , Doença Celíaca/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Humanos , Doença Imunoproliferativa do Intestino Delgado/diagnóstico por imagem , Neoplasias Intestinais/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Síndromes de Malabsorção/induzido quimicamente , Síndromes de Malabsorção/etiologia , RadiografiaRESUMO
Segmental ischemic disease consists of segmental infarctions and ischemic stenoses. Vasculitis (LES, polyarteritis nodosa, Schönlein-Henoch syndrome), thrombosis, arteriosclerotic changes, mechanical obstructions (adhesions, hernia, volvulus, traumas), hemorrhagic disorders are the most common causes of these intestinal lesions. The authors report their experience achieved during three years on 428 small bowel examinations; among these, 197 were double contrast enemas. Ten patients showed roentgenographic features referred to vascular diseases: 1 LES, 1 Schönlein-Henoch syndrome, 3 polyarteritis nodosa, 5 spontaneous hemorrhagic disorders or due to treatment with anticoagulants. The authors, after a review of the radiological findings, emphasize the high sensitivity and low specificity of double contrast small bowel enema. Furthermore they underline the usefulness of this method in demonstrating and monitoring intestinal pathologic changes.
Assuntos
Intestino Delgado/irrigação sanguínea , Isquemia/diagnóstico por imagem , Sulfato de Bário , Constrição Patológica/diagnóstico por imagem , Humanos , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/patologia , Isquemia/etiologia , Isquemia/patologia , Mesentério/irrigação sanguínea , Mesentério/diagnóstico por imagem , RadiografiaAssuntos
Divertículo/diagnóstico por imagem , Intestino Delgado , Adulto , Divertículo/etiologia , Feminino , Humanos , Masculino , RadiografiaRESUMO
In mechanical subocclusions, when there isn't immediate urgency, is it possible and necessary to probe radiologic examination, for a better surgical evaluation. The authors describe their own experience, achieved in about 3 years, on small bowel double contrast enema. They examined 143 patients; 16 of them were suboccluded. The security and the diagnostic reliability of used method are stressed by the authors to define lesions' morphology and localization.