Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy?

Aliment Pharmacol Ther 31 , 523–533

Summary

Background Common reasons for elective screening and surveillance colonoscopy, at predetermined intervals, are family or personal history of colorectal cancer (CRC) or advanced adenoma (AAP). Quantified, human haemoglobin (Hb)‐specific, immunochemical faecal occult blood tests (I‐FOBT) detect bleeding. Aim To determine I‐FOBT sensitivity for CRC or AAP before elective colonoscopy in patients at high‐risk of cancer or advanced adenoma. Methods Prospective double‐blind study of 1000 ambulatory asymptomatic high‐risk patients (555 family history of CRC, 445 surveillance for past neoplasm), who prepared three I‐FOBTs before elective colonoscopy. I‐FOBTs quantified as ngHb/mL of buffer by OC‐MICRO instrument and results ≥50 ngHb/mL considered positive. Results At colonoscopy, eight patients had CRC, 64 others had AAP. Sensitivity for CRC and/or AAP was the highest, 65.3% (95% CI 54.3, 76.3), when any of the three I‐FOBTs was ≥50 ngHb (15.4%), with specificity of 87.5% (95% CI 86.4, 90.5) identifying all CRCs and 62% of AAPs. Conclusions All cancers or an AAP were detected every third I‐FOBT‐positive colonoscopy (47/154), so colonoscopy was potentially not needed at this time in 84.6% (846 patients). I‐FOBT screening might provide effective supervision of high‐risk patients, delaying unnecessary elective colonoscopies. This favourable evaluation needs confirmation and cost–benefit study by risk‐group.     

Pneumopericardium Following Radiofrequency Ablation for Atrial Fibrillation: Insights into the Natural History of Atrial Esophageal Fistula Formation

Pneumopericardium Following Atrial Fibrillation Ablation. We present a case of large pneumopericardium resulting from an esophageal pericardial fistula following ablation for atrial fibrillation (AF). The presentation, evaluation, and management of this specific patient, along with a review of present techniques to diagnose esophageal injury, provide a unique insight into the pathophysiology of left atrial‐esophageal fistula formation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1046‐1049, September 2010)     

Percutaneous Epicardial Left Atrial Appendage Closure: Preliminary Results of an Electrogram Guided Approach

Background: Pharmacologic therapies to prevent stroke in atrial fibrillation (AF) have numerous limitations, prompting the development of device-based therapies. We investigated whether an electrogram-based approach using a novel hollow suture can safely capture and ligate the left atrial appendage (LAA).
Methods and Results: A novel system for closure of the LAA within the confines of the closed pericardium with a single sheath puncture was tested in 4 dogs. The tool used to grasp the appendage was fitted with electrodes and utilized electrical navigation to identify and confirm LAA capture. A hollow suture preloaded with a mechanical support wire to permit its manipulation and fluoroscopic visualization was advanced over the grasper, and the wire removed after the suture was positioned. The LAA was successfully closed in all dogs. In 2 dogs, after closure, a thoracotomy was performed and the LAA amputated without bleeding, confirming closure integrity. Necropsy confirmed closure in all animals.
Conclusions: Using electrical navigation, percutaneous epicardial LAA ligation with a remotely tightened suture was performed successfully within the confines of the intact pericardial space. This technique may allow decreasing the risk of stroke in AF patients without the need for thoracotomy or an endocardially placed prosthetic device.     

INFLUENCE OF FORMULA CONCENTRATION ON CALORIC INTAKE AND GROWTH OF NORMAL INFANTS

ABSTRACT: Fomon, S. J., Filer, L. J., Jr, Thomas, L. N., Anderson, T. A. and Nelson, S. E. (Department of Pediatrics, University Hospital, University of Iowa, Iowa City, USA). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatr Stand, 64:172, 1975.–Fifteen fullterm female infants were enrolled in each of two feeding groups and all but one completed the proposed period of observation to age 112 days. Formulas prepared from the same ingredients (fat-free milk solids, a mixture of corn and coconut oils, lactose, vitamins and minerals) were fed ad libitum to both groups. Formula concentration was 54 kcal/100 ml for one group and 100 kcal/100 ml for the other. A limited selection of commercially prepared strained foods was permitted after 28 days of age. Weighed intakes of food were recorded for each day of study. During the interval 8 through 41 days of age, the infants fed the 54 kcal/100 ml formula consumed a considerably greater quantity of food but fewer calories than did those fed the 100 kcal/100 ml formula. Those fed the 54 kcal/100 ml formula also gained less weight. These differences between feeding groups were statistically significant. After 41 days of age, mean caloric intakes (kcal/kg/day) and rates of gain in weight were similar for the two feeding groups. The data provide a basis for speculation on the possible difference in allocation of calories to growth and non-growth in the two groups.     

REQUIREMENTS FOR PROTEIN AND ESSENTIAL AMINO ACIDS IN EARLY INFANCY1Studies with a Soy-Isolate Formula

Thirteen normal female infants were observed from 8 through 111 days of age while receiving a diet providing 1.62 g of protein per 100 kcal, almost entirely from soy-isolate. Clinical observations, growth rates and serum concentrations of albumin were similar to those of female infants fed milk-based formulas providing greater intakes of protein. On the basis of these findings, it is assumed that the requirements for protein and essential amino acids of these infants were no greater than the amounts consumed. Reasons for preferring to express requirements for proteins and amino acids per unit of calorie intake rather than per unit of body weight are presented. The preliminary estimates of requirements presented here are believed applicable when the diet is adequate in total calories and non-nitrogenous essential nutrients, nitrogen is provided primarily in the form of whole proteins, and protein intakes do not greatly exceed the requirement. For reasons discussed, the approach is likely to yield estimates of requirements for some amino acids that are substantially greater than the true requirements. Nevertheless, our estimates of requirements for isoleucine and methionine are distinctly less than those reported by Holt & Snyderman. We conclude that the estimates of Holt & Snyderman from studies of infants fed mixtures of amino acids are less relevant than our estimates to circumstances in which whole proteins are fed in amounts that do not greatly exceed the requirement for protein.