Raman fiber-optical method for colon cancer detection: Cross-validation and outlier identification approach.

Endoscopy plays a major role in early recognition of cancer which is not externally accessible and therewith in increasing the survival rate. Raman spectroscopic fiber-optical approaches can help to decrease the impact on the patient, increase objectivity in tissue characterization, reduce expenses and provide a significant time advantage in endoscopy. In gastroenterology an early recognition of malign and precursor lesions is relevant. Instantaneous and precise differentiation between adenomas as precursor lesions for cancer and hyperplastic polyps on the one hand and between high and low-risk alterations on the other hand is important. Raman fiber-optical measurements of colon biopsy samples taken during colonoscopy were carried out during a clinical study, and samples of adenocarcinoma (22), tubular adenomas (141), hyperplastic polyps (79) and normal tissue (101) from 151 patients were analyzed. This allows us to focus on the bioinformatic analysis and to set stage for Raman endoscopic measurements. Since spectral differences between normal and cancerous biopsy samples are small, special care has to be taken in data analysis. Using a leave-one-patient-out cross-validation scheme, three different outlier identification methods were investigated to decrease the influence of systematic errors, like a residual risk in misplacement of the sample and spectral dilution of marker bands (esp. cancerous tissue) and therewith optimize the experimental design. Furthermore other validations methods like leave-one-sample-out and leave-one-spectrum-out cross-validation schemes were compared with leave-one-patient-out cross-validation. High-risk lesions were differentiated from low-risk lesions with a sensitivity of 79%, specificity of 74% and an accuracy of 77%, cancer and normal tissue with a sensitivity of 79%, specificity of 83% and an accuracy of 81%. Additionally applied outlier identification enabled us to improve the recognition of neoplastic biopsy samples.

Feasibility of a colon capsule overnight procedure followed by colonoscopy.

BACKGROUND AND AIM: Due to limited acceptance of colonoscopy as diagnostic and screening test alternatives are warranted. Colon capsule endoscopy (CCE) has been shown to be a possible filter test, but because of logistical issues a second bowel preparation is usually required, if consecutive colonoscopy is needed. We therefore evaluated the feasibility of a single bowel preparation for both overnight CCE and (therapeutical) colonoscopy thereafter. METHODS: Patients from two university hospitals referred to undergo colonoscopy were prospectively included in a dual centre feasibility study. A polyethylene glycol (PEG) based bowel preparation-schedule with ingestion of a colon capsule endoscopy (CCE) at 10pm and subsequent colonoscopy at about 12am on the next day was investigated. The first generation PillCam colon capsule was used with 4 different preparation protocols containing several prokinetics in different compositions (i. e. metoclopramide, erythromycin, sennosoides). The main endpoint was the proportion of patients who completed both CCE and colonoscopy; secondary endpoints were capsule transit times, amount of colon seen on CCE, bowel cleanliness, sensitivity and specifity of CCE and patients' acceptance. RESULTS: 50 patients between 18 and 75 years were included. The sequence of overnight colon capsule endoscopy and colonoscopy was successfully completed in all but one (one refused colonoscopy). The capsule was excreted during recording time in 86 % of examinations, visualization of the complete colon was possible in 60 %, but adequate colon preparation was achieved in only 45 % irrespective of the regimen used. The preparation regimen consisting of a PEG-solution, erythromycin as prokinetic drug followed by PEG-solution as boost showed the largest proportion of adequate preparations. Overall sensitivity and specificity of CCE for polyps of any size were 65 % and 76 %, respectively. 26 of 30 patients (86.7 %) returned the subjective assessment questionnaire. 23 patients (88 %) reported mild to no discomfort or embarrassment during CCE, whereas 15 patients (58 %) did during the preparation procedure. Drinking the purgative solution was the most inconvenient step in 84 % of cases, drinking the boosts during CCE the second inconvenient step (60 %). CONCLUSION: Overnight CCE-procedure followed by direct capsule-reading is feasible and safe and might avoid repetitive bowel preparation for subsequent colonoscopy. The bowel preparation needs to be improved.

[S3 guideline--Diagnosis and treatment of colorectal carcinoma: relevance for radiologic imaging and interventions]. / Aktualisierte S3--Leitlinie zur Diagnostik und Therapie des kolorektalen Karzinoms: Bedeutung für die Radiologische Diagnostik und Intervention.

The new German S3 guideline "Colorectal Carcinoma" was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008. With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed. The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes.The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution.

[Dyspnea and weight loss in a 70-year-old man]. / Dyspnoe und Gewichtsverlust bei einem 70-jährigen Patienten.

A 70-year-old man presented with subacute dyspnea, cough, weight loss, and mild fever. Blood analysis revealed an elevated C-reactive protein level. Chest x-ray and CT of the chest showed alveolar opacities with a migratory tendency during the clinical course. After extensive diagnostics, treatment with prednisolone under the presumed diagnosis of a cryptogenic organizing pneumonia was started, which lead to a rapid clinical response.

[83-year-old patient with salmonella bacteremia and infection-associated Sweet's syndrome]. / 83-jähriger Patient mit Salmonellenbakteriämie und Infekt-getriggertem Sweet-Syndrom.

HISTORY AND PHYSICAL EXAMINATION: An 83 year-old man presented with watery diarrhea and a rash. He was hypotensive, febrile and dehydrated. The rash was maculopapular and most pronounced on the dorsal trunk. INVESTIGATIONS: The lab tests showed an acute renal failure with hypokalemia and hyponatremia. Salmonella typhimurium was isolated from the aerobic blood culture, stool cultures were negative. The rash was consistent with an infection-associated Sweet's syndrome. THERAPY AND COURSE OF DISEASE: The patient was admitted and received iv fluids and potassium. An empiric antibiotic treatment with i. v. ciprofloxacin was started and changed to p. o. after 8 days. Antibiotic therapy was given 11 days total. After the administration of steroids the skin rash resolved. CONCLUSION: It is important to draw blood cultures in patients presenting with diarrhea if fever is present. Complications associated with non-typhoidal salmonella bacteremia occur most frequently in elderly patients and include pneumonia, infected aneurysms and bone/soft part infections. In rare cases patients can also present with a skin rash.

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Management of lesions detected in colorectal cancer screening.

Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on management of lesions detected in colorectal cancer screening includes 32 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of the screening process, including multi-disciplinary diagnosis and management of the disease.

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Colonoscopic surveillance following adenoma removal.

Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on colonoscopic surveillance following adenoma removal includes 24 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of surveillance and other elements in the screening process, including multi-disciplinary diagnosis and management of the disease.

[Fever of intermediate duration after return from the Canary Islands]. / Fieber mittlerer Dauer nach Rückkehr von den Kanaren.

A 35 year old patient presented to the emergency room with high fever, headache and a maculopapular rash after returning from the Canary Islands. Elevated levels of LDH and transaminases and thrombopenia developed during the further hospital course. This presentation is common for an infection with Rickettsia typhi. Therapy with doxycycline is usually effective and should be instituted promptly. The patient's fever remitted 48 h after the first dose. Fever of intermediate duration has been described as a separate disease entity in the Mediterranean region and the Canary Islands. It is defined as fever of 7-28 days duration for which a complete basic workup fails to define an etiology. Most cases are due to one of six infectious diseases (Q fever, Mediterranean spotted fever, endemic typhus, leptospirosis, brucellosis and mononucleosis).