The first results of the "bevolkingsonderzoek" in the Zaanstreek region in The Netherlands.

This short communication describes the results with respect to stage of colorectal cancer in people detected via screening and patients with clinical complaints.

Individual polyp detection rate in routine daily endoscopy practice depends on case-mix.

INTRODUCTION: The adenoma detection rate (ADR), a marker of endoscopic quality, is confounded by selection bias. It is not known what the ADR is in normal daily practice. AIM: To study the polyp detection rate (PDR) in different endoscopists in the course of years. PATIENTS AND METHODS: All consecutive endoscopies of the colon done in 11 years were included. Endoscopies in the regular surveillance programme after polyp removal and after surgery because of colorectal cancer or diverticular disease were scored separately. The number of yearly procedures per endoscopist and presence of polyps, anastomoses, surveillance and cancer were noted. RESULTS: In the period of 11 years, 14,908 consecutive endoscopies of colon and rectum were done by four endoscopists. Two endoscopists had a significantly lower PDR than the other two (p < 0.001), these two had the longest careers in endoscopy. The two younger endoscopists did significantly less often procedures in patients with anastomoses and because of surveillance (p < 0.001, respectively). One endoscopist detected significantly less colorectal cancers than the other three endoscopists (p < 0.001). CONCLUSION: This study presents the PDR in normal routine daily endoscopy practice. It can be concluded that the PDR, implicating the ADR, in unselected patients can be lower in individual endoscopists than recommended in the literature. This highly depends on the case-mix of patients presented for endoscopy. This result debates the use of the ADR as quality indicator for individual endoscopists.

The effect of flumazenil on visual event-related potentials of clinically non-encephalopathic patients with cirrhosis.

The effects of flumazenil on the latencies and amplitudes of visual event-related potentials (ERPs), number-connection test (NCT) and visual and auditory reaction times (VRT and ART) were evaluated in ten patients with cirrhosis without clinically overt encephalopathy (HE). Delayed latencies of the ERP component P3a and/or P3b were found in three patients and the time to complete NCT was prolonged in two other patients. Changes in the latencies and amplitudes of the ERP components (N200, P3a and P3b) during 40 min following infusion of flumazenil (1 mg) and placebo were similar. Results of the three psychometric tests did not change significantly after either flumazenil or placebo infusion. Eight of the ten patients felt more alert for several minutes after the administration of flumazenil, whereas no patient experienced any change of perception after infusion of placebo. Prolongation of the latencies of P3a and P3b may be a component of the syndrome of subclinical HE. However, these neuro-electrophysiological abnormalities in cirrhotic patients may not be attributable to increased brain levels of natural benzodiazepines.

A Case of Extreme Gastroparesis due to an Occult Small Cell Cancer of the Lung.

A patient with gastroparesis is presented. Ultimately the diagnosis of paraneoplastic gastroparesis due to an occult small cell cancer of the lung was made. The difficulties in the diagnostic process and the pathogenesis of this very rare manifestation are discussed.

The changing prevalence of upper gastrointestinal endoscopic diagnoses: a single-centre study.

INTRODUCTION: Upper gastrointestinal (GI) endoscopy is increasingly applied in daily practice. Not many data are available on yearly changes in diagnostic yield, nor on changes in morbidity. AIM: To study the possible changes in occurrence of abnormalities in the oesophagus, stomach and duodenum. METHODS: All consecutive upper GI endoscopies performed over a period of 20 years were included. Important diagnoses were defined as: oesophagitis, metaplastic epithelium in the oesophagus, hiatal hernia or defective sphincter, ulcers, erosive or nodular gastritis, operated stomach, and cancer. RESULTS: In the 20-year period, 29,218 upper GI endoscopies were performed. 'Open-access' endoscopy, i.e. at the request of the general practitioner, showed a clear increase in the first ten years and remained stable thereafter. A trend towards an increase in macroscopic abnormalities was seen. The presence of hiatal hernia and defective sphincter showed a significant increase over 20 years, while the number of patients with reflux oesophagitis showed a less impressive, but still significant increase (p<0.001) in the first ten years and remained stable thereafter. There was an impressive decrease in the incidence of peptic ulcer disease. Prevalence of oesophageal cancer showed a gradual increase, although the numbers were very low. CONCLUSIONS: In a period of 20 years the diagnostic yield of upper GI endoscopy showed significant changes. Reflux disease increased in prevalence while peptic ulcer disease decreased.

The yearly prevalence of findings in endoscopy of the lower part of the gastrointestinal tract.

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42-370. The number of colonoscopies was mean 1126, range of 643-1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years.

Visual event-related potentials in cirrhotic patients without overt encephalopathy.

UNLABELLED: Ambulant patients with cirrhosis and no clinical evidence of encephalopathy were screened for impaired brain function by neuroelectrophysiological testing dependent on cognitive function. Infrequent large checkerboard visual stimuli were randomly interleaved with frequent small ones to elicit P300 event-related potentials (ERPs). Three ERP components, N200, P3a and P3b, were derived from the electroencephalogram (EEG) by computer averaging. The use of 10% contrast and a minimum of four precisely placed scalp electrodes were found to be necessary for optimal separation of ERPs from sensory evoked potentials. Visual ERPs, onset/offset and pattern-reversal visual evoked potentials (VEPs), the spontaneous EEG and the time taken to complete a standard number connection test (NCT) were obtained from 20 normal adult subjects and 19 age-matched patients with histologically-confirmed cirrhosis and no clinical evidence encephalopathy. The latencies and amplitudes of evoked potentials and the alpha rhythm of the EEG were determined. In 6 of the 19 patients the latencies of P3a and/or P3b exceeded the corresponding mean for controls + 2 standard deviations of that mean. In 4 other patients the NCT was prolonged. In all of the patients the N200, VEPs and alpha rhythm of the EEG were normal. IN CONCLUSION: (i) Optimal isolation of ERPs is critically dependent on stimulus contrast and electrode placement; (ii) ERPs appear to be more sensitive than primary sensory evoked potentials or the EEG in detecting impaired brain neuroelectrophysiological function; and (iii) Cirrhotic patients without overt encephalopathy in whom P3a and/or P3b latencies are prolonged may have subclinical hepatic encephalopathy.

Visual event-related potentials in cirrhotic patients without overt encephalopathy: the effects of flumazenil.

The P300 complex was derived from the electroencephalogram (EEG) as subjects mentally counted infrequent large checkerboard visual stimuli, presented randomly among frequent small checkerboard stimuli. Use of low contrast (10%) stimuli and four midline scalp electrodes, facilitated separation of cognitive and sensory components and enabled the P300 complex to be resolved into three distinct components--N200, P3a, and P3b. In 20 healthy adult subjects normative data were established and the P3a and P3b components were shown to depend on cognitive function. In 19 age-matched cirrhotic patients without overt hepatic encephalopathy (HE) the EEG and visual evoked potentials (VEPs) were normal, but latencies of P3a and/or P3b were prolonged in 9. Prolonged latencies were not associated with an abnormal number connection test. Ten additional age-matched cirrhotic patients without overt HE, who were alcohol, drug, and caffeine free, were randomized to receive flumazenil (1 mg) and placebo intravenously, double-blind. After flumazenil or placebo, latencies of P3a and P3b and psychometric test results did not change significantly. These findings suggest that in cirrhotic patients without overt HE (i) impaired cognitive sensory function may occur in the absence of abnormalities of a standard psychometric test, the EEG, or VEPs, and (ii) increased latencies of P3a and P3b may constitute a component of subclinical HE, which is not mediated by increased brain levels of central benzodiazepine receptor agonist ligands.