ABSTRACT
OBJECTIVE: Increased mortality from respiratory diseases was observed in epidemiological studies of patients with ulcerative colitis [UC] as a potentially underestimated extraintestinal manifestation. We therefore investigated the presence of pulmonary manifestations of inflammatory bowel disease [IBD] and the potential effect of tumour necrosis factor alpha [TNF-α] inhibitors on pulmonary function tests [PFT] in a prospective, longitudinal study. METHODS: In all, 92 consecutive patients with IBD (49 Crohn´s disease [CD], 43 UC) and 20 healthy controls were recruited. Fifty patients with IBD were in remission, and 42 had active disease with 22 of these being examined before and 6 weeks after initiating anti-TNF therapy. Pulmonary function tests [PFT] were evaluated using the Medical Research Council [MRC] dyspnoea index and a standardized body plethysmography. IBD activity was assessed using Harvey-Bradshaw index for CD and partial Mayo score for UC. Data are presented as mean ± standard error of the mean [SEM]. RESULTS: Patients with active IBD showed significant reduction of PFT. Forced expiration [Tiffeneau index] values [FEV1%] were significantly reduced in IBD patients with active disease [78.8 ± 1.1] compared with remission [86.1 ± 0.9; p = 0.0002] and with controls [87.3 ± 1.3; p = 0.001]. Treatment with anti-TNF induced a significant relief in obstruction [p = 0.003 for FEV1% in comparison with baseline levels]. The level of pulmonary obstruction significantly correlated with clinical inflammation scores [HBI or Mayo]. CONCLUSIONS: PATIENTS: with active IBD present with significant obstructive abnormalities in their PFTs. Obstruction is related to inflammatory activity, with anti-TNF improving PFTs. Pulmonary obstruction and possibly chronic bronchopulmonary inflammation is an overlooked problem in active IBD that is probably obscured by intestinal symptoms.
Subject(s)
Forced Expiratory Volume/physiology , Inflammatory Bowel Diseases/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic use , Adalimumab/therapeutic use , Adult , Case-Control Studies , Female , Humans , Inflammatory Bowel Diseases/physiopathology , Infliximab/therapeutic use , Longitudinal Studies , Male , Middle Aged , Plethysmography , Prospective Studies , Respiratory Function TestsABSTRACT
BACKGROUND: Diagnosis of inflammatory bowel disease (IBD) is based on clinical presentation, colonoscopy and histology. Differentiation of Crohn's disease (CD) and ulcerative colitis (UC) can be difficult in some patients. Endoscopic ultrasound (EUS) provides high resolution images of the gastrointestinal wall (GI) and may be an alternative to differentiate CD/UC. AIM: EUS of the GI layers in patients with IBD and healthy controls (HC) for the differential diagnosis of UC/CD in a prospective, blinded study. METHODS: Consecutive patients with CD, UC or HC underwent EUS in the mid sigmoid colon with a forward-viewing radial echoendoscope. Mucosal, submucosal, total wall thickness (TWT) and locoregional lymphnodes (LN) were assessed by EUS in a blinded fashion. TWT was correlated with macroscopic IBD scores and histological inflammation scores. RESULTS: Total wall thickness of 61 HC was 1.71 ± 0.02 mm, and 3.51 ± 0.15 mm in n = 52 with active IBD. In patients with active UC significant thickening of the mucosa was observed but nearly normal submucosa and m.propria. In active CD significant thickening of the submucosal layer was seen with nearly normal mucosa and m.propria [MucosaUC = 2.08 ± 0.11 mm, MucosaCD = 1.32 ± 0.17 mm (P = 0.0001); SubmucosaUC = 1.01 ± 0.08 mm, SubmucosaCD = 2.01 ± 0.22 mm (P = 0.0001)]. In 73.7% of patients with active CD, but in none with UC, paracolonic lymph nodes were detected. When mucosal-submucosal and TWT and LNs were combined, the sensitivity was 92.3% for the differentiation of active UC/CD. There was a strong correlation of TWT with histological inflammation scores (UC: r = 0.43; CD: r = 0.69). CONCLUSIONS: Increased total wall thickness has a high positive predictive value for active IBD. EUS can differentiate active UC from CD and quantify the level of colonic inflammation.
Subject(s)
Colitis, Ulcerative/diagnosis , Colonoscopy/methods , Crohn Disease/diagnosis , Endosonography/methods , Adult , Aged , Case-Control Studies , Colitis, Ulcerative/pathology , Crohn Disease/pathology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prospective Studies , Single-Blind MethodABSTRACT
BACKGROUND AND STUDY AIMS: Insertion of a percutaneous endoscopic gastrostomy (PEG) is standard care for many patients with oropharyngeal (ENT) and esophageal malignancies in order to ensure enteral feeding. The current pull-through insertion technique involves direct contact with the tumor and case reports have demonstrated the presence of metastases at insertion sites. The aim of the current study was to prospectively evaluate the risk of malignant cell seeding and the development of abdominal wall metastases after PEG placement. PATIENTS AND METHODS: A total of 50 consecutive patients with ENT/esophageal tumors were included. After PEG placement (40 pull-through technique, 10 direct insertion), brush cytology was taken from the PEG tubing and the transcutaneous incision site. A second cytological assessment was performed after a follow-up period of 3 - 6 months. RESULTS: In total, 26 patients with ENT cancer, 13 with esophageal cancer, and one with esophageal infiltration of lung cancer underwent pull-through PEG placement with no immediate complications. Cytology following brushing of tubing and incision sites demonstrated malignant cells in 9 /40 cases (22.5 %). Correlation analyses revealed a higher rate of malignant seeding in older patients and in those with higher tumor stages. At follow-up, cytology was undertaken in 32 /40 patients who had undergone pull-through PEG placement. Malignant cells were present in three on cytology, resulting in a metastatic seeding rate of 9.4 %. CONCLUSION: This study showed that malignant cells were present in 22.5 % of patients immediately after pull-through PEG placement; local metastases were verified at follow-up in 9.4 %, all of which were from esophageal squamous cell carcinoma. This risk is particularly high in the older age group and in patients with higher tumor stages. Therefore, pull-through PEG placement should be avoided in these patients and direct access PEG favored instead.
Subject(s)
Abdominal Neoplasms/secondary , Abdominal Wall/pathology , Carcinoma, Squamous Cell/secondary , Esophageal Neoplasms/pathology , Gastrostomy/adverse effects , Neoplasm Seeding , Oropharyngeal Neoplasms/pathology , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/mortality , Aged , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/mortality , Cytodiagnosis , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/methods , Esophageal Neoplasms/mortality , Esophageal Neoplasms/surgery , Female , Follow-Up Studies , Gastrostomy/methods , Humans , Male , Middle Aged , Oropharyngeal Neoplasms/mortality , Oropharyngeal Neoplasms/surgery , Prospective Studies , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
We measure the carrier envelope offset (CEO) frequency of the mid-infrared frequency comb (wavelength tunable between 3 and 6 µm) from a doubly resonant nondegenerate synchronously pumped optical parametric oscillator (SPOPO) as a function of the CEO frequency of the Tm-fiber pump laser. We show that the CEO frequency of the SPOPO signal wave is a linear function of the CEO frequency of the pump laser, with a slope determined by the signal to pump center-frequency ratio.
ABSTRACT
Intracavity loss modulation enables offset-frequency control with bandwidths beyond what is possible by pump power modulation. To demonstrate this new method, we use a subwavelength thick graphene electro-optic modulator to stabilize the offset frequency in a Tm:fiber frequency comb at 1.95 µm wavelength. Record-low residual phase noise of 144 mrads was achieved with this new locking scheme.
ABSTRACT
Supercontinuum generation in a water-filled photonic crystal fiber is reported. By only filling the central hollow core of this fiber with water, the fiber properties are changed such that the air cladding provides broadband guiding. Using a pump wavelength of 1200 nm and few-microjoule pump pulses, the generation of supercontinua with two-octave spectral coverage from 410 to 1640 nm is experimentally demonstrated. Numerical simulations confirm these results, revealing a transition from a soliton-induced mechanism to self-phase modulation dominated spectral broadening with increasing pump power. Compared to supercontinua generated in glass core photonic fibers, the liquid core supercontinua show a higher degree of coherence, and the larger mode field area and the higher damage threshold of the water core enable significantly higher pulse energies of the white light pulses, ranging up to 0.39microJ.
Subject(s)
Fiber Optic Technology/instrumentation , Lasers , Lighting/instrumentation , Water , Crystallization , Equipment Design , Equipment Failure AnalysisABSTRACT
A fast implementation of the Gabor wavelet transform for phase retrieval in spectral interferometry is discussed. This algorithm is experimentally demonstrated for the characterization of a supercontinuum, using spectral phase interferometry for direct electric-field reconstruction (SPIDER). The performance of wavelet based ridge tracking for frequency demodulation is evaluated and compared to traditional Fourier filtering techniques. It is found that the wavelet based strategy is significantly less susceptible toward experimental noise and does not exhibit cycle slip artifacts. Optimum performance of the Gabor transform is observed for a Heisenberg box with unity aspect ratio. As a result, the phase jitter of 60 individual measurements is reduced by about a factor 2 compared to Fourier filtering, and the detection window increases by 20%. With an optimized implementation, retrieval rates of several 10Hz can be reached, which makes the fast Gabor transform a superior one-to-one replacement even in applications that require video-rate update, such as a real-time SPIDER apparatus.
ABSTRACT
The influence of calcitonine, amino acids, ribonucleid acids, kallikrein, growth hormone, and cyclic adenosine 3'5' monophosphate on fracture repair was tested in rabbits. To obtain an objective measurement of callus stability the bones were bent mechanically. The force applied and the degree of bending were recorded continuously. The slope of the curve was taken as a parameter of callus stability. In the series with calcitonine no influence on fracture healing was found. Injections of ribonucleic acids, amino acids, kallidrein, and growth hormone demonstrated a limited effect on bone repair. Callus formation was stimulated by adenosine 3'5' monophosphate. Optimal results were achieved by a combination of adenosine 3'5' monophosphate, amino acids, ribonucleic acids, and kallikrein.