Usefulness of Warm Water and Oil Assistance in Colonoscopy by Trainees

Background and Study Aims

Success rate of cecal intubation, endoscopist’s difficulty, and procedure-related patient pain are still problems for beginners performing colonoscopy. New methods to aid colonoscopic insertion such as warm water instillation and oil lubrication have been proposed. The aim of this study is to evaluate the feasibility of using warm water or oil in colonoscopy.

Methods

Colonoscopy was performed in 117 unsedated patients by three endoscopists-in-training. Patients were randomly allocated to three groups, using a conventional method with administration of antispasmodics, warm water instillation, and oil lubrication, respectively. Success rate of total intubation within time limit (15 min), cecal intubation time, degree of endoscopist’s difficulty, and level of patient discomfort were compared among the three groups.

Results

Cecal intubation time was shorter in the warm water group than in the conventional and oil groups. Degree of procedural difficulty was lower in the warm water group, and patient pain score was higher in the oil lubrication group, compared with the other groups. However, there was no significant difference in success rate of intubation within time limit among the three groups.

Conclusions

The warm water method is a simple, safe, and feasible method for beginners. Oil lubrication may not be a useful method compared with conventional and warm water method.     

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

AIM: To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy. METHODS: Patients who developed biliary complications were analysed in detail for the clinical information,laboratory tests,treatment offered,response to it,follow up and outcomes. The profile of liver enzymes was determined. The safety,efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed. RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L,P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L,P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients. CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early,non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.     

Application of sensitive enzymeimmunoassay for determination of cortisol in blood plasma of yaks (Poephagus grunniens L.)

As an alternative to radioimmunoassays, a simple, highly sensitive and quick enzymeimmunoassay (EIA) for determination of cortisol in blood plasma of yaks on microtiterplates using second antibody coating technique and cortisol-horseradish peroxidase as a label has been developed. The wells of the microtiterplate were coated with affinity-purified goat IgG (antirabbit IgG) that binds the hormone specific antibody. The EIA was carried out directly in 20 microl of heat treated plasma after 1:5 dilution with PBS. The cortisol standard curve, with doses ranged from 0.4 to 100 pg/well. The sensitivity of the assay was 20 pg/ml. Cortisol standard curve in buffer showed parallelism with serially diluted yak plasma containing high endogenous cortisol. Intra- and inter-assay coefficients of variation (CV) determined using pooled plasma was found 6.58 and 11.35%, respectively. Recovery of known concentrations of added cortisol in charcoal stripped plasma was linear (r = 0.98). For biological validation of cortisol enzymeimmunoassay, the blood samples were collected from yak cows at -48 and -24h before and 0, 12, 24, 36, 48, 60, 72, 84 and 96 h after dexamethasone administration. The plasma cortisol before dexamethasone administration was significantly (P < 0.05) higher than after dexamethasone administration. The developed EIA was further validated biologically by estimating cortisol in peri-parturient cows beginning day 10 prior to calving till day 10 post-calving; the concentrations were along with the expected lines as reported in bovine. In conclusion, the EIA developed in this study is simple, highly sensitive, valid and sufficiently reliable method for estimation of cortisol directly in bovine plasma.     

Cognitive insight and acute psychosis in schizophrenia

Cognitive insight is a new concept. There are very few data regarding the relationship between cognitive insight and positive symptoms. The goal of the present study was to investigate the impact of acute psychosis (delusions and hallucinations) on overconfidence in judgments and self-reflectiveness of patients with schizophrenia. The Beck Cognitive Insight Scale was used to compare the cognitive insight of schizophrenia patients with (n = 93) and without (n = 45) current psychotic symptoms. Clinical symptoms and clinical insight of the patients were also assessed. The present findings suggest that both overconfidence in judgments and impaired self-reflectiveness are associated with acute psychosis. Only diminished self-reflectiveness seem to be improved following hospitalization. Although overconfidence of schizophrenia patients in their judgments was more severe in schizophrenia patients with psychotic symptoms, self-certainty of schizophrenia patients may be a relatively persistent characteristic that is also present after recovery of psychosis. Studies with larger samples involving follow up for longer periods will be valuable to understand the nature of the relationship between cognitive insight and clinical symptoms of schizophrenia.     

Portal hypertension and obstructive jaundice after hepatic interventions: report of two unusual complications

We report two unusual complications after a transjugular intrahepatic portosystemic shunt and a biliary stent placement, respectively. One patient with cirrhosis and portal hypertension developed obstructive jaundice secondary to compression of the right hepatic duct by a stent graft placed in the transjugular intrahepatic portosystemic shunt. In another patient, biliary stents caused obstruction of the portal vein, resulting in symptomatic portal hypertension. An awareness of these possible complications is important for early diagnosis and appropriate treatment of such complications.     

Radiologically placed tunneled internal jugular catheters in the management of chronic hemodialysis and long-term infusion therapies in the pediatric population

PURPOSE: To evaluate the long-term outcomes of radiologically inserted dual-lumen hemodialysis and infusion catheters in pediatric patients. MATERIALS AND METHODS: The authors retrospectively reviewed the outcomes of 114 tunneled internal jugular catheters in 71 consecutive pediatric patients between March 2003 and May 2006. Forty hemodialysis catheters were placed in 23 patients (11 girls, 12 boys), and 74 infusion catheters were placed in 48 patients (14 girls, 34 boys). The mean patient age was 11.2 years (range, 1-16 years) in the hemodialysis group and 7.86 years (range, 4 months to 16 years) in the infusion group. RESULTS: The technical success rate was 100%. The mean duration of catheter use was 84 days (range, 5-730 days) in the hemodialysis group and 58 days (range, 3-206 days) in the infusion group. Nine hemodialysis (22%) and 29 infusion (39%) catheters were electively removed. The most common reasons for catheter removal were malfunction (22%) in the hemodialysis group and completion of therapy (39%) in the infusion group. Revisions were performed at a rate of 0.6 and 0.4 per 100 catheters days in the hemodialysis and infusion groups, respectively. Total infection rates were 0.15 and 0.38 episodes per 100 catheter days in hemodialysis and infusion catheters, respectively. Mean primary device service intervals were 86 and 60 days for hemodialysis and infusion catheters, respectively, with total access site service intervals of 140 and 71 days. CONCLUSION: Radiologically placed tunneled internal jugular catheters appear to be safe and effective, with very low complication rates for both hemodialysis and long-term infusion therapies. Higher infection rates were seen in patients with cancer.     

Theory of mind impairment: a distinct trait‐marker for schizophrenia spectrum disorders and bipolar disorder?

Objective: The aim of this study was to critically review the literature in order to determine if Theory of Mind (ToM) impairment can be considered a trait‐marker for schizophrenia spectrum disorders and bipolar disorder (BD). Method: After a thorough literature search, we reviewed the empirical studies investigating ToM impairments in remitted schizophrenia patients, first episode patients, subjects at high‐risk (HR) for psychosis and first‐degree relatives of schizophrenia patients. Studies investigating ToM impairment in other schizophrenia spectrum conditions, affective psychosis and BD were also reviewed. Results: ToM abnormalities exist at onset and continue throughout the course of schizophrenia, persist into remission, and while less severe, are apparent in HR populations. Mentalizing impairments are also observed in other forms of psychotic illness and BD. Conclusion: Mentalizing impairment in schizophrenia spectrum disorders and BD might reflect underlying general cognitive deficits and residual symptom expression, rather than representing a specific trait‐marker.