Background Probe-based confocal laser endomicroscopy (pCLE) is an emerging tool for in vivo imaging of the GI tract that requires the endoscopist to interpret microscopic images. The learning curve ...for interpretation of pCLE images is unknown. Objective To examine the learning curve of correctly identifying benign and neoplastic colorectal lesions by using pCLE and to evaluate the learning curve of obtaining high-quality images. Design Prospective, double-blind review of pCLE images of 76 colorectal lesions by using corresponding polypectomies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 76 unknown images. Setting Eleven endoscopists from 3 different endoscopy centers evaluated the images obtained by 1 endoscopist using the high-definition confocal probe. Patients Patients undergoing screening and surveillance colonoscopies. Intervention Intravenous fluorescein pCLE imaging of colorectal lesions followed by polypectomies. Main Outcome Measurements Accuracy of image interpretation with constructing learning curve for pCLE image interpretation and acquisition. Results Of the 76 colorectal lesions, 51 (67%) were neoplastic and 25 (33%) were benign, based on histopathology. Accuracy for the overall group was 63% for lesions 1 to 20, 64% for lesions 21 to 40, 79% for lesions 41 to 60, and 86% for lesions 61 to 76. The ability to obtain high-quality images was stable over the 76 cases. Limitations Small sample size and use of offline video sequences. Conclusions Accurate interpretation of pCLE images for predicting neoplastic lesions can be learned rapidly by a wide range of GI specialists. Furthermore, the ability to acquire high-quality pCLE images is also quickly learned.
Gastroesophageal reflux disease is a common disorder in all patients but a particular problem in the elderly, for whom the disease often presents with advanced mucosal damage and other complications. ...Symptoms are also not as reliable an indication of disease severity in older patients. Likewise, therapy is more difficult because of potential side effects and drug interactions.
Treatment of noncardiac chest pain is often difficult because of the heterogeneous nature of the disorder. This condition can stem from gastroesophageal reflux, visceral hyperalgesia, esophageal ...motility disorders, psychiatric dysfunction, abnormal biomechanical properties of the esophageal wall, sustained esophageal contractions, abnormal cerebral processing of visceral stimulation, or disrupted autonomic activity. For a treatment to be successful, diagnosis of the underlying cause is essential. This article examines three decades of studies from around the world. It concludes that new research into additional mechanisms involved in visceral pain appears promising; but that future studies using improved selective adenosine receptor antagonists and other therapeutic interventions are needed.
Noncardiac chest pain and fibromyalgia Almansa, Cristina; Wang, Benjamin; Achem, Sami R
The Medical clinics of North America,
03/2010, Letnik:
94, Številka:
2
Journal Article
Recenzirano
Fibromyalgia (FM) remains an enigmatic and challenging clinical entity to manage, given its far-reaching spectrum of symptoms, chronicity, associated psychopathology, and lack of clinically available ...diagnostic tests. However, recent insights into the pathophysiology of FM offer hope that this condition, as with all members of the central sensitization syndromes, can be more readily diagnosed, measured, and treated. This paper presents the epidemiology features and pathogenesis of FM in the context of evaluating NCCP as a prototype among central pain sensitization syndromes. Evidence for the multimodality approach to treatment of this condition is also presented.
We report a patient with an unusual cause of chronic intestinal pseudoobstruction, i.e., neuronal intestinal dysplasia. This disorder is characterized by hyperplasia of the nerve plexuses of the ...intestine or colon, or both. Detailed morphologic and manometric studies are provided. The discussion emphasizes the various motor abnormalities that may be found in chronic intestinal pseudoobstruction. We propose that rectal biopsy may be of value in the diagnosis of this unusual form of pseudoobstruction.
