An approach to acute lower gastrointestinal bleeding.

Lower gastrointestinal bleeding (LGIB) is a common problem that can be treated via a number of endoscopic, radiological and surgical approaches. Although traditionally managed by the colorectal surgeons, surgery should be considered a last resort given the variety of endoscopic and radiological approaches available. This article provides an overview on the common causes of acute LGIB and the various techniques at our disposal to control it.

What is the best algorithm for investigation of acute lower gastrointestinal haemorrhage?

An 81-year-old male presented with multiple episode of severe PR bleeding over 2 days. CTA done prior to catheter angiography that enabled successful intervention. This case emphasises the importance of CTA prior to catheter angiography in acute LGIB.

Spontaneous thrombosis of congenital extrahepatic portosystemic shunt (Abernethy malformation) simulating inguinal hernia incarceration.

Tender lumps in the inguinal region are often explored emergently to treat suspected hernial strangulation. We discuss the case of an adult male who presented acutely with a tender inguinal swelling and raised inflammatory markers and was therefore deemed as requiring surgical exploration. However preoperative abdominal computerized tomography (CT) revealed an extensive thrombosing congenital venous malformation of portosystemic origin with extension into the symptomatic inguinal canal. A potentially lethal exsanguination from surgery was thus avoided.

A comparison of sodium phosphosoda purgative to polyethylene glycol bowel preparations prior to colonoscopy.

BACKGROUND AND OBJECTIVES: Successful colonoscopy is contingent upon adequate bowel preparation, which is often achieved using either an oral sodium phosphate preparation or a polyethylene glycol-based preparation. Comparison of the relative performance of these two classes of agents has been assessed only in the context of clinical trials (and with mixed findings). However, efficacy measured in clinical trials often is not reflective of effectiveness in clinical practice. We undertook this analysis to determine the relative clinical effectiveness of oral sodium phosphosoda versus polyethylene glycol in clinical practice. METHODS: Subjects (n=343) were selected from among patients receiving outpatient colonoscopy at our institution between January 2004 and February 2006. Demographic, biochemical, and comorbid disease data were abstracted from the electronic medical record. Colonoscopy preparation, indication, and preparation quality were abstracted from colonoscopy reports. RESULTS: As compared to subjects receiving polyethylene glycol, those receiving oral sodium phosphosoda had an adjusted odds ratio (OR) (95% confidence intervals [CIs]) for adequate/good/excellent bowel preparation quality of 2.23 (1.18--4.22) and an adjusted OR (95% CIs) for good/excellent bowel preparation of 2.24 (1.26--3.97). There was no interaction on the basis of colonoscopy indication. CONCLUSIONS: Oral sodium phosphate-based purgatives were associated with significantly better bowel preparation quality among outpatients at our center.

Kinetic FP-TDI assay for SNP allele frequency determination.

Strategies for identifying genetic risk factors in complex diseases by association studies require the comparison of allele frequencies of numerous SNPs between affected and control populations. Theoretically, hundreds of thousands of SNP markers across the genome will have to be genotyped in these studies. Genotyping SNPs one sample at a time is extremely costly and time consuming. To streamline whole genome association studies, some have proposed to screen SNPs by pooling the DNA samples initially for allele frequency determination and perform individual genotyping only when there is a significant discrepancy in allele frequencies between the affected and control populations. Here we describe a new method for determining the allele frequency of SNPs in pooled DNA samples using a two-color primer extension assay with real-time monitoring of fluorescence polarization (named kinetic FP-TDI assay). By comparing the ratio of the rate of incorporation of the two allele-specific dye-terminators, one can calculate the relative amounts of each allele in the pooled sample. The accuracy of allele frequency determination with pooled samples is within 3.3 +/- 0.8% of that determined by genotyping individual samples that make up the pool.

Relapsing acute adult epiglottitis following hypophysectomy.

Adult epiglottitis is an uncommon disease that may become fatal because of sudden airway obstruction. Recurrent adult epiglottitis has been reported rarely in the literature. We present a case of relapsing epiglottitis in a patient with corticosteroid insufficiency secondary to pituitary surgery. It is the first case to highlight this infection occurring in a relapsing manner in a patient with pituitary-adrenocortical insufficiency on long-term steroid replacement therapy.