Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial.

BACKGROUND: In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. METHODS: The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. FINDINGS: 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P<0·001). INTERPRETATION: This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

Substance P in rectal mucosa of children with chronic constipation.

Substance P content was determined by radioimmunoassay in rectal mucosa of 17 children with idiopathic constipation and 9 with normal bowel movements who were used as controls. In children with chronic idiopathic constipation, rectal mucosa substance P levels were lower than levels in the control group: 47.6 +/- 11 vs. 79.4 +/- 11 pg/mg net weight respectively (differences not statistically significant). Substance P levels in rectal mucosa of children with soiling (11/17) did not differ from those of chronically constipated children without soiling (46.0 +/- 16 vs. 50.5 +/- 19 pg/mg net weight). In children with constipation, substance P levels did not correlate either with age or duration of symptoms. Substance P levels in normal controls were similar to levels previously observed in non-constipated adults, whereas levels in constipated children were intermediate between levels observed in healthy subjects and levels in adults with chronic constipation. These findings may point to a motility derangement as a possible factor in the pathogenesis of chronic constipation in childhood.

Substance P in rectal mucosa of children with chronic constipation

Niveles de Substancia P fueron determinados por radioinmunoassay en la mucosa rectal de 17 niños con constipación, idiopática crónica y comparados con la de 9 ninõs sin constipación. En el grupo de niños con constipación, los niveles de Sustancia P fueron menores que aquellos de los controles: 47,6+-11 vs. 79,4+-11 pg/mg de peso húmero de tejido respectivamente (la diferencia no obtuvo significación estadística). Niveles de Sustancia P en la mucosa rectal de niños con soiling (11/17) no fueron diferentes de los niveles en niños constipados sin soiling (46,0+-13 vs. 50,5+-19). En niños con constipación, los niveles de Sustancia P no varían de acuerdo a la edad o la duración de síntomas. Los niveles de Sustancia P en la mucosa rectal de niños controles (sin constipación) fueron similares a aquellos que previamente observamos en adultos normales, y los niveles en niños constipados fueron intermediarios entre estos niveles normales y los de adultos constipados. Estas observaciones sugieren un problema de motilidad como factor importante en la patogenesis de la constipación crónica en niños.

Substance P in rectal mucosa of children with chronic constipation

Niveles de Substancia P fueron determinados por radioinmunoassay en la mucosa rectal de 17 niños con constipación, idiopática crónica y comparados con la de 9 nin÷s sin constipación. En el grupo de niños con constipación, los niveles de Sustancia P fueron menores que aquellos de los controles: 47,6+-11 vs. 79,4+-11 pg/mg de peso húmero de tejido respectivamente (la diferencia no obtuvo significación estadística). Niveles de Sustancia P en la mucosa rectal de niños con soiling (11/17) no fueron diferentes de los niveles en niños constipados sin soiling (46,0+-13 vs. 50,5+-19). En niños con constipación, los niveles de Sustancia P no varían de acuerdo a la edad o la duración de síntomas. Los niveles de Sustancia P en la mucosa rectal de niños controles (sin constipación) fueron similares a aquellos que previamente observamos en adultos normales, y los niveles en niños constipados fueron intermediarios entre estos niveles normales y los de adultos constipados. Estas observaciones sugieren un problema de motilidad como factor importante en la patogenesis de la constipación crónica en niños. (AU)

Substance P in rectal mucosa of children with chronic constipation.

Substance P content was determined by radioimmunoassay in rectal mucosa of 17 children with idiopathic constipation and 9 with normal bowel movements who were used as controls. In children with chronic idiopathic constipation, rectal mucosa substance P levels were lower than levels in the control group: 47.6 +/- 11 vs. 79.4 +/- 11 pg/mg net weight respectively (differences not statistically significant). Substance P levels in rectal mucosa of children with soiling (11/17) did not differ from those of chronically constipated children without soiling (46.0 +/- 16 vs. 50.5 +/- 19 pg/mg net weight). In children with constipation, substance P levels did not correlate either with age or duration of symptoms. Substance P levels in normal controls were similar to levels previously observed in non-constipated adults, whereas levels in constipated children were intermediate between levels observed in healthy subjects and levels in adults with chronic constipation. These findings may point to a motility derangement as a possible factor in the pathogenesis of chronic constipation in childhood.

EsophaCoil: long-term results in 81 patients.

BACKGROUND: Cancer of the esophagus and gastric cardia cause progressive dysphagia. Half of patients are not amenable to surgical resection; of those who are, about 20% will suffer either from local recurrence or anastomotic strictures. Self-expandable metallic stents of diverse characteristics have been used in these clinical conditions. However, expandable metallic stents have several drawbacks: low radial force, migration, epithelial trauma, and tumor ingrowth. We herein report our long-term experience with EsophaCoil, a self-expandable esophageal metallic coil, in 81 patients. METHODS: From January 1993 to July 1996, 84 stents were placed in 81 consecutive patients (53 men and 28 women, mean age 69.8 years (range 40 to 90 years). 41 patients had esophageal squamous cell carcinoma, 32 adenocarcinoma of the esophagus and cardia, 5 mediastinal metastasis, 1 sarcoma, and 2 had benign esophageal strictures. Five patients had bronchoesophageal fistulas. Mean dysphagia score before treatment was 3.5, mean stricture length 6 cm. Most patients were hospitalized for at least 24 hours after stent implantation. Patients were followed and early and late complications were recorded. RESULTS: Stents were successfully placed in all patients. Dysphagia improved in 96% of patients (score dropped from 3.5 to 1.2). Mean patient survival after stent insertion was 4 months (range 0.5 to 20 months). Bronchoesophageal fistulas were closed in all 5 cases. Early complications occurred in 11 patients. These were severe in 3 (esophageal perforation) and mild in 8 patients (precordial pain lasting 24 to 48 hours). Late complications occurred in 18 patients and included migration to the stomach (5 patients), stent breakage (5 among the first 20 cases), food impaction (5), tumor overgrowth (2), and bleeding (1). CONCLUSIONS: In a long-term follow-up, EsophaCoil was effective in the palliative treatment of dysphagia caused by malignant esophageal strictures, including cases of fistulas, having low malfunction and migration rates. No tumor ingrowth was seen.

Adenoacantoma del esofago superior: presentacion de un caso / Adenocanthoma of the upper esophagus: report of a case

We report 72 years old woman, with adenoacamthoma of the upper osophagus who was admitted in Hospital israelita "EZRAH" in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case

Adenoacantoma del esofago superior: presentacion de un caso / Adenocanthoma of the upper esophagus: report of a case

We report 72 years old woman, with adenoacamthoma of the upper osophagus who was admitted in Hospital israelita "EZRAH" in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case (AU)

[Adenoacanthoma of the upper esophagus. Report of a case]. / Adenoacantoma del esófago superior. Presentación de un caso.

We report a 72 year-old woman, with adenoacanthoma of the upper esophagus who was admitted in Hospital Israelita "EZRAH" in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case.

Adenoacantoma del esófago superior. Presentación de un caso. / [Adenoacanthoma of the upper esophagus. Report of a case]

We report a 72 year-old woman, with adenoacanthoma of the upper esophagus who was admitted in Hospital Israelita [quot ]EZRAH[quot ] in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case.

Adenoacantoma del esófago superior. Presentación de un caso. / [Adenoacanthoma of the upper esophagus. Report of a case]

We report a 72 year-old woman, with adenoacanthoma of the upper esophagus who was admitted in Hospital Israelita [quot ]EZRAH[quot ] in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case.