Human myiasis in middle Europe]

A report is given on 4 cases of myiasis of the mucous membrane of different localisation and etiology observed in the GDR (vaginal myiasis by Lucilia sericata, urethral and vesicular myiasis by Calliphora vicina, rectal myiasis by Sarcophaga haemorrhoidalis and ophthalmomyiasis by Oestrus ovis). Biological peculiarities and habits of life of the causative organisms, pathogenesis of the different forms of parasitosis in man and clinical pictures are described. The cases mentioned show that occasionally is to reckoned with autochthonic myiasis - above all due to larve of blue-bottles, meat and bot-flies - not only in tropic countries, but also in Middle Europe (especially during the warm seasons and when a considerable quantity of flies is present). Among the predisposing factors for furunculous and migrating skin myiasis as well as wound, urogenital, intestinal and other myiases of the mucous membrane comatous conditions due to severe basic diseases play a special part. On unhygienic conditions, however, the parasitic invasion of the maggots of certain, in general harmless species of flies into the integumentum and into various hollow organs of man is just possible also in primarily healthy persons with good general condition. In an adequate anamnesis and suspicious clinical symptomatology, therefore, a myiasis should be included into differential-diagnostic considerations.     

结膜蝇蛆病一例

患者女性,26岁,洛阳市偃师佃庄镇黄庄村人.2003年9月8日就诊,自诉行走时右眼撞一飞物,2 h后眼内有异物感、刺痛、怕光、流泪.检查发现结膜充血,结膜囊内及睑结膜、球结膜上见有黑头的白色虫体移动,共取出18条,之后症状消失.经鉴定,虫体为白色,梭形,长约1 mm.显微镜观察其头部有粗大黑色的头咽骨,前端1对黑色弯曲的口钩,其周围有刺数圈,口钩有的突出于体外,有的缩于体内.虫体分12节,体节上有毛刺环绕,体末节分左右两叶呈扇状排列,鉴定为羊狂蝇Ⅰ龄幼虫.     

Endoscopy in pregnancy

Endoscopy is rarely required during pregnancy. The potential risks of endoscopy during pregnancy include foetal hypoxia due to sedative drugs and exposure to radiation. There is no evidence that endoscopy precipitates premature labour, and studies in this area have concluded that endoscopy during pregnancy is generally safe. There should be a strong indication for the procedure, which should be deferred whenever possible to the second trimester. Procedures should be performed without any sedation, or with the lowest dose of sedative medication. Radiation exposure should be kept to a minimum. Support should be obtained from specialists in obstetrics and anaesthesia. Indications for endoscopy during pregnancy are as follows: (1) gastroscopy: upper gastrointestinal bleeding, dysphagia, uncontrolled nausea/vomiting; (2) sigmoidoscopy/colonoscopy: rectal bleeding, diarrhoea; and (3) ERCP: choledocholithiasis, biliary pancreatitis. Sedative drugs, such as midazolam appear to be safe if used carefully. Radiation exposure during ERCP can be kept well below the danger level for teratogenicity.     

Training in Endoscopy

Purpose of the review

Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees.

Recent findings

Increasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees. These differences may be dependent on the trainee, trainer and training programme. Evidence of the benefit of knowledge-based training, simulation training, hands-on courses and clinical training is available to inform the planning of ideal training pathway elements. The validation of performance assessment measures and global competency tools now also provides evidence on the effectiveness of training programmes to influence the learning curve. The impact of technological advances and intelligent metrics from national databases is also predicted to drive improvements and efficiencies in training programme design and monitoring of post-training outcomes.

Summary

Training in endoscopy may be augmented through a series of pre-training and in-training interventions. In conjunction with performance metrics, these evidence-based interventions could be implemented into training pathways to optimise and quality assure training in endoscopy.