Repeat capsule endoscopy in suspected gastrointestinal bleeding

Objectives: This study aims to review the utility of repeat capsule endoscopy (CE) with on-going concern of small bowel (SB) bleeding following initial SB investigation with CE.

Materials and methods: A specifically designed database of CE examinations performed over 13 years, with hospital records, was retrospectively interrogated for patients undergoing multiple CEs to investigate iron deficiency anaemia (IDA) or suspected SB bleeding.

Results: 1335/2276 (58.7%) of CEs were performed to investigate IDA or SB bleeding; 92 were repeat CEs carried out for ongoing clinical concern. The median time interval between initial and repeat CE procedures was 466.5 (range 1–3066) days. Twenty-four patients had initially normal CE; on repeat examination, abnormalities were detected in 11/24 (45.8%). 3/21 (14.2%) of patients with angioectasia on first CE had alternative causes for IDA or GI bleeding detected on repeat CE. Six patients with active bleeding, without an identifiable source on initial CE, undergoing repeat CE had a cause isolated in 5/6 (83.3%). Changing CE device did not affect diagnostic yield (DY) compared to repeat CE using the same device (27.5% to 26.8%).

Conclusions: It is known that CE can miss clinically relevant and serious lesions. Our results suggest that patients with an initially negative or inconclusive CE frequently have a cause of SB bleeding detected on repeat CE. The DY of repeat CE is highest in those with bleeding on their initial CE (83.3%) and lower in those with initially normal examinations (45.8%) or when an alternative cause, such as angioectasia is seen (14.2%).     

林国华针灸治疗难治性突发性耳聋经验撷要

总结林国华教授针灸治疗难治性突发性耳聋经验,并对典型医案进行介绍。林国华教授认为本病多因少阳经气厥塞所致,提倡尽早针灸干预,治病求本,谨守"少阳暴厥"之病机,谨遵"疏解少阳,通耳开窍"之法,临证必用听宫,主取少阳经穴,辅予辨经取穴,巧施发蒙针法与气流灌耳法,妙用岭南火针疗法,必要时调气调神、加取募穴,共奏通耳复聪之效。     

Cardiac Surgery in Patients With Liver Cirrhosis (CASTER) Study: Early and Long-Term Outcomes

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Laparoendoscopic Single-site Surgery for Comprehensive Staging of Early Ovarian Cancer

Study ObjectiveTo demonstrate the procedure and suspension skills of laparoendoscopic single-site (LESS) staging surgery with infrarenal para-aortic lymphadenectomy for early-stage ovarian cancer.DesignA presentation of the surgery through this technical video.SettingA hospital.Patient and InterventionsA 45-year-old woman presented with a pelvic mass on gynecologic examination and a serum cancer antigen 125 level of 5910 U/mL (normal = <35 U/mL). A computed tomographic scan revealed a mixture of solid and cystic components (70 × 77 × 71 mm) arising from the right ovary and characterized by the “ovarian vascular pelvic” sign. Clinically early-stage ovarian cancer was suspected. Subsequently, LESS staging surgery was performed by an experienced surgeon in our department.ResultsThe surgery lasted 280 minutes, and the volume of blood loss was 50 mL; there were no intra- or postoperative complications. We “hid” the incision perfectly for cosmetic purposes. The histopathologic findings supported high-grade serous ovarian cancer of the right ovary with the left fallopian tube involved as well. In addition, a total of 34 negative pelvic and 18 negative para-aortic lymph nodes were identified, and a stage of IIA was diagnosed as a result.ConclusionWe performed an LESS staging surgery for early-stage ovarian cancer successfully. Our video shows that the LESS approach provided feasible, cosmetic, and safe access among the selected malignant gynecologic surgery. Therefore, we have experienced that the effective suspension was an auxiliary measure for LESS lymphadenectomy. In addition, compared with multiport laparoscopy, the LESS approach could provide easier access to infrarenal para-aortic regions; furthermore, it was safe and quick to extract an unknown sample.     

Nation's compensation for war wounds and work incapacities. The creation of a new welfare system for physically disabled veterans and civilians of the First World War in Interwar Belgium, 1918–1928

This article explores the creation of a new social welfare system for physically disabled veterans and civilians of the Great War in Belgium during the early interwar period. Through an analysis of debates among ministers and legislators, doctor's opinions and the member's periodicals of the two largest national associations for war-wounded veterans and civilians it examines how these actors shaped a new set of benefits that caused significant socio-economic inequalities inside and between both groups of victims and in relation to physically disabled citizens without war injuries. Consequently, this article reveals how the welfare system characterised a reimagining of war compensation, the physically disabled worker and disability equality in Belgium.