Wireless capsule endoscopy in the diagnostic of small intestine angiodysplasia in chronic uremic patient.

Gastroenteric bleeding due to angiodysplasia (AD) is a relatively common occurrence in patients with end-stage renal failure. Gastric and colon angiodysplasic lesions can be easily revealed by endoscopic procedures, whereas lesions of the small intestine are more difficult to detect. Imaging modalities used in the diagnostic imaging algorithm for the detection of small-bowel AD, include non-invasive methods like enema-helical computer tomography,(99m)Tc-labelled red blood cell scintigraphy, and angiography, and invasive methods such as intraoperative enteroscopy. We report the cases of 3 hemodialysis patients with recurrent episodes of gastrointestinal bleeding, caused by small-bowel AD diagnosed by means of wireless-capsule endoscopy. In all cases, previous gastroscopy and colonoscopy were unrevealing. Wireless-capsule endoscopy consists in swallowing a capsule endoscope (11 mmx27 mm) which contains a miniature video camera, a light source, batteries, and a radio transmitter. Video images are transmitted by means of radio telemetry to aerials taped to the body that allow images to be captured. Moving images from a period as long as 6 h are stored on a portable recorder. Wireless-capsule endoscopy may prove valuable in the assessment of gastrointestinal bleeding in uremic patients with unrevealing results at gastroscopy and colonoscopy.

[Angiodysplasia of the small bowel: a possible cause of anemia even in mild chronic renal failure]. / Angiodisplasia dell'intestino tenue: una possibile causa di anemizzazione nell'IRC anche di grado lieve.

BACKGROUND: Gastroenteric angiodysplasia (AD) is a vascular lesion characterized by vascular ectasias to the submucous sheath of the gastrointestinal tract. Lesions can be flat or raised, isolated or grouped and can break or ulcerate causing acute hemorrhage or, more commonly, chronic bleeding. CASE-REPORT: We describe a 65-year-old patient with a 3-yr history of chronic renal failure (CRF), who gradually developed anemia (hemoglobin (Hb) 10 g/dl) without any episodes of clinically relevant bleeding or any exposure to bleeding risk factors. Blood pressure (BP) was normal and renal function was stable (serum creatinine (Cr) 1.9 mg/dl). Routine laboratory tests showed a slight reduction in serum iron and transferrin saturation and a slightly elevated absolute reticulocyte count. These findings were associated with a positive occult gastrointestinal blood test and raised the clinical suspicion of chronic gastrointestinal blood loss. Oesophagogastro-duodenoscopy and colonoscopy demonstrated an absence of significant lesions, suggesting the need to investigate for a lesion localized in the small intestine. Capsular endoscopy, a recently developed endoscopic technique, particularly suited for small bowel pathology, was performed, and demonstrated the presence of an angiodysplasic lesion, located in the jejunum. CONCLUSIONS: Our case report supports the necessity for a complete clinical and laboratory evaluation of the possible causes of anemia superimposed on relative erythropoietin deficiency in CRF patients. When gastrointestinal blood loss is suspected, the entire gastroenteric tract should be examined to search for the bleeding sites. Our report also demonstrates that AD could be responsible for gastrointestinal bleeding even in mild CRF and not only, as usually reported, in end-stage renal disease (ESRD). Capsular endoscopy offers the unique possibility to determine the bleeding site in the small intestine and appears as an effective diagnostic procedure in CRF patients.

2-Nitrosoimino-3,6-dihydro-2H-1,3,4-thiadiazines with antiplatelet and antithrombotic properties.

The successful synthesis of 17 nitrosimines of 2 H-1,3,4-thiadiazines is reported. They are best characterized by their electronic spectra (lambda max = 504-522 nm). Some of the compounds were able to inhibit the aggregation of blood platelets in the Born-test (inducer collagen). The most active compound was the 3-nonyl-5-phenyl-derivative 10c which showed an IC50 = 6.5 mumol.l-1. In mesenteric arterioles of rats after p.o. administration (60 mg/kg) a 13% inhibition of thrombus formation is observed. The reason for the rather small effects is the high chemical stability of the title compounds and the fact that decomposition occurs mainly by the evolution of molecular nitrogen. Only small yields of NO are formed.

[Results of radiculomyelography with dimer-X following lumbar intervertebral disk operations]. / Ergebnisse der Radikulomyelographie mit Dimer-X nach lumbalen Bandscheibenoperationen.

In radiculomyelogram after operation of lumbar intervertebral disk has been investigated an adhesive arachnopathy in 24 out of 86 patients. It appears increased in patients with two operations of the intervertebral disk, revision of several intervertebral spaces and after massed prolapses. The etiological importance of hyperosmolar X-ray contrast media is comparatively slight. Characteristical clinical findings were not evident in patients with arachnopathy. In some patients the protein content in cerebrospinal fluid was raised, it could be observed as an unspecific reaction and a relative monocytosis in the cytogram. Two third of the patients with recurrent nucleus pulposus prolapse were diagnosed rightly by radiculomyelography, though there are difficulties in the differentiation of adhesive-fibrotic changes.