Gastrointestinal bleeding and small bowel amyloidosis.

Amyloidosis commonly affects the gastrointestinal tract but it rarely causes severe symptoms. We describe here a case of small bowel amyloidosis presenting severe bleeding. The diagnosis was made by histopathological study of the surgical specimen. No other sites of amyloid deposition were found. The only predisposing condition found in this case was a prostate cancer.     

Diagnostic yield of small bowel capsule endoscopy depends on the small bowel transit time

AIM: To investigate whether the small bowel transit time (SBTT) influences the diagnostic yield of capsule endoscopy (CE).METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure.RESULTS: There was a positive correlation between the diagnostic yield and SBTT (Spearman’s rho 0.58, P < 0.01). Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding (r = 0.54, P < 0.01), for polyposis and carcinoid combined (r = 0.56, P < 0.01) and for the other indications (r = 0.90, P <0.01), but not for suspected Crohn’s disease (r = -0.40).CONCLUSION: The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time. This is true for all indications except for suspected Crohn’s disease.     

Diagnostic dilemma

In those issues in which our regular Case of the Month does not appear, The Green Journal will present a Diagnostic Dilemma-an electrocardiogram and/or radiograph with a brief case history-for our readers to solve. The correct answer appears on p. 511 of this issue.If you would like to contribute a Diagnostic Dilemma, please submit a high-quality copy of the EKG or radiograph with a brief synopsis (<250 words) of the case to The American Journal of Medicine's editorial office.     

Diagnostic dilemma

In those issues in which our regular Case of the Month does not appear, The Green Journal will present a Diagnostic Dilemma-an electrocardiogram or radiograph, or both, with a brief case history-as a challenge for our readers to solve. The correct answer appears on page 742. If you would like to contribute a Diagnostic Dilemma, please submit a high-quality copy of the ECG or radiograph with a brief synopsis (<250 words) of the case to editorial office of the American Journal of Medicine.     

Diagnostic dilemma

In those issues in which our regular Case of the Month does not appear, The Green Journal will present a Diagnostic Dilemma—an electrocardiogram or radiograph, or both, with a brief case history—as a challenge for our readers to solve. The correct answer appears on page 741. If you would like to contribute a Diagnostic Dilemma, please submit a high-quality copy of the electrocardiogram or radiograph with a brief synopsis (fewer than 250 words) of the case to the editorial office of The American Journal of Medicine.     

胶囊内镜在小肠肿瘤诊断中的作用

目的 探讨胶囊内镜在诊断小肠肿瘤中的作用及对其治疗的价值.方法 收集2002年5月至2007年2月因疑似小肠疾病而行胶囊内镜检查者共358例,对其中疑诊小肠肿瘤者作进一步检查,根据内镜或手术病理结果明确诊断.结果 358例中共明确诊断小肠肿瘤33例(男14例,女19例),平均年龄(51±17)岁,发现率为9.22%,其中恶性肿瘤23例,占69.70%,良性肿瘤10例,占30.30%.临床表现分别为不明原因消化道出血26例、出血伴腹痛2例、腹痛2例,腹痛伴腹泻1例,腹泻伴出血1例,呕吐1例.良性肿瘤组行手术治疗后原有症状基本消失,恶性肿瘤组2例未行手术治疗,3例行姑息性手术治疗,18例彻底切除病灶.胶囊内镜所提示病变部位与术中发现病灶位置基本吻合.结论 胶囊内镜对小肠肿瘤具有较高的检出率,且小肠肿瘤中以恶性者居多.经胶囊内镜明确诊断后将彻底改变对患者的治疗策略.