Is formal training necessary for capsule endoscopy? The largest gastroenterology trainee study with controls.

BACKGROUND: Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified. AIMS AND METHODS: To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees. RESULTS: Trainees were better at determining the gastric emptying time (p=0.013) and more likely to record true positives compared to the students (p=0.037). They were also less likely to record false positives (p=0.005) and more likely to reach the correct diagnosis (p=0.001, OR 3.6, CI 1.8-7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training. CONCLUSION: This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.

Reconstruction of urethrovaginal fistula and vaginal atresia in an adolescent girl after an abdominoperineal-vaginal pull-through procedure.

OBJECTIVE: To report a rare case of urethrovaginal communication and vaginal atresia. DESIGN: To reconstruct the communication and the vaginal route. SETTING: Division of Pediatric and Adolescent Gynecology and Corrective Gynecological Surgery, University of Athens, and "Alexandra" Hospital. PATIENT(S): A 16-year-old girl with cyclic hematuria, periodic pelvic pain, and primary amenorrhea. INTERVENTION(S): Diagnostic studies, followed by an abdominoperineal-vaginal pull-through procedure. MAIN OUTCOME MEASURE(S): Reconstruction of the urethrovaginal fistula and vaginal route. RESULT(S): Normal menstruation through the vaginal route. CONCLUSION(S): A careful examination of every infant's external genitalia should be performed immediately after delivery. A urethrovaginal fistula should be corrected in time to facilitate menstrual flow and improve future reproductive potential.

Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome.

To investigate the conditions that have developed in the treatment of posttraumatic meningitis with the use of new antibiotics, the authors studied cases with this infection retrospectively for a period of 68 months. Among 860 patients with moderate to severe head injuries, 12 (1.39%) sustained this complication. Of these, nine patients (75%) had a demonstrable basilar skull fracture and seven (58.3%) presented obvious rhinorrhea. Of these seven, four (57.1%) were treated conservatively and three (42.8%) finally underwent surgery for dural repair. The infecting agents were Gram-positive cocci (Staphylococcus haemolyticus, Staphylococcus warneri, Staphylococcus cohnii, Staphylococcus epidermidis, and Streptococcus pneumoniae) in five patients and Gram-negative bacilli in six patients (Escherichia coli in two, Klebsiella pneumoniae in two, and Acinetobacter anitratus in two). In one patient, the culture results were negative. All Gram-negative strains appeared resistant to ampicillin and third-generation cephalosporins, but sensitive to imipenem and to the quinolone ciprofloxacin. Gram-positive strains were sensitive to vancomycin. Hydrocephalus finally developed in the two patients who had received intrathecal infusions of amikacin. No other report of the relation of intrathecal infusion of antibiotics and the development of hydrocephalus was found. All patients survived, indicating that, for the present, posttraumatic meningitis is a nonfatal complication of head injury.

Outcome in severely head injured patients with and without multiple trauma.

BACKGROUND: This work attempts to analyse the potential role of multiple injury in the outcome of non-shock severely head injured patients with a Glasgow Coma Scale (GCS) of 8 or less. METHODS: 386 non-shock adult patients of < 65 years (mean age 33.74 +/- 14.7), treated with the same therapeutic protocol, were studied retrospectively. Multiple traumatised patients classified into Injury Severity Scale (ISS) of < or = 9 and > 9. The ISS classification was also tested in two subgroups of patients with GCS 3-5 and GCS 6-8. RESULTS: The overall mortality of the 386 patients was 22.79%. Those suffering from extracranial injuries (n = 146, 37.82%) and those without (n = 240), presented similar mortality (21.23% vs 23.75% respectively). The multiple traumatised victims presented mean ISS 9.3 +/- 8.17. Those with ISS > 9 had greater mortality than those with ISS < or = 9, but the difference was not statistically significant (p > 0.05). The influence of ISS was not also significant in the mortality, either patients were of GCS 3-5 or GCS 6-8. CONCLUSIONS: Multiple trauma in non-shock patients, as it is expressed by ISS does not have any influence on mortality. Mortality is depending on the severity of the intracranial pathology. Perhaps head injury and extracranial injuries have synergistic effect on morbidity.

Retroperitoneal endometriosis causing cyclical ureteral obstruction.

We report a case of retroperitoneal endometriosis involving the periureteral tissues of the left ureter. The patient suffered from cyclical symptoms of left ureteral obstruction during menstruation. Endometriosis of the ureter is not common and in this case the preoperative diagnosis presented difficulties due to the absence of any pathological findings during the clinicolaboratory evaluation of the patient before or after menstruation. The patient was managed with surgical resection of the affected ureteral segment and subsequent end-to-end anastomosis of the left ureter. A brief review of the subject is also presented.

Mutation spectrum and phenotypic manifestation in FSHD Greek patients.

Facioscapulohumeral muscular dystrophy (FSHD) is a genetic myopathy with a remarkable intra- and inter-familial clinical heterogeneity. This study reports the clinical and genetic analysis of 133 individuals from 71 unrelated Greek families based on a revised clinical severity score (rCSS) index which was developed for clinical assessment regarding the disease progression. A high ratio (31/62, 50%) of probands' family members was found to be asymptomatic or minimally affected gene carriers of a contracted 4q allele. Moreover, a notable clinical variability of FSHD is reported concerning the detection of an identical de novo 13 b EcoRI fragment in monozygotic twins, as well as indications of founder effect. This is the first survey that presents data of FSHD families from an East Mediterranean country supporting the speculation that the prevalence of disease might be significantly underestimated and that synergistic factors could play an essential role on the progression of the disease.

Periapical actinomycosis: report of a case and review of the literature.

This case of periapical actinomycosis presented the clinical picture of chronic periapical inflammation. The diagnosis was based on the histological examination of the periapical lesions suggesting the necessity for routine histological examination. Although root canals provide a primary port of entry the Actinomyces organisms into the periapical tissue, periapical actinomycosis, is considered extremely rare. This may be due to the omission of routine histological examination of periapical lesions and the clinical behavior of the disease. The large number of cases reported during the last decade indicates that periapical actinomycosis is more frequent than what it is believed and this is important in the daily dental practice.

Computer tomographic long-time results after surgical removal of subdural fluid collections in infancy and childhood.

61 infants and children underwent surgery of acute hygroma, acute subdural hematoma, chronic subdural hygroma, chronic subdural hematoma, and subdural empyema. Long time-follow up including computerized tomography could be performed in 20 of these cases. Only 3 CT-scans had been without pathological finding. The most common finding had been an enlargement of the inner and outer CSF spaces suggesting cerebral atrophy. No correlation had been found to kind of surgical treatment and clinical status.

[Aplasia of the arteria carotis interna in a male patient with congenital myotonia (author's transl)]. / Aplasia der Arteria carotis interna mit Myotonia congenita.

In a 54 year old man who suffered from a myotonia congenita an intracranial aneurysm was suspected. Cerebral angiography revealed an aplasia of the left internal carotid artery. This very rare anomaly has not yet been described together with a myotonia congenita.

Studies on the Bcg signal in infants.

In this report, we studied the relationship between respiratory and cardiac rates derived from a modified Bcg and for comparison from the thermistor and the ECG in infants from a new-born baby to a 13-year-old boy. The results with fair correlation coefficients support us in our opinion that this method is worth taking into consideration. Although the number of disturbances is not negligible, this indirect method offers a harmless control of vital parameters in childhood and adolescence. It gives reliable data without any trouble to the patients. In a period of increasing malpractice accusations, it could be of some interest to have a monitoring device working without any direct contact with the patient.

Intramural leiomyoma of the bladder.

Mesodermal tumors of the urinary bladder are rare and the majority of them are malignant. We report a case of an intramural leiomyoma of the bladder presenting with symptoms of a mild lower urinary tract infection. The patient was managed with partial cystectomy and the outcome was excellent.