Clinical study using novel endoscopic system for measuring size of gastrointestinal lesion

AIM:To verify the performance of a lesion size measurement system through a clinical study.METHODS:Our proposed system,which consists of a conventional endoscope,an optical device,an optical probe,and a personal computer,generates a grid scale to measure the lesion size from an endoscopic image.The width of the grid scale is constantly adjusted according to the distance between the tip of the endoscope and lesion because the lesion size on an endoscopic image changes according to the distance.The shape of the grid scale was corrected to match the distortion of the endoscopic image.The distance was calculated using the amount of laser light reflected from the lesion through an optical probe inserted into the instrument channel of the endoscope.The endoscopist can thus measure the lesion size without contact by comparing the lesion with the size of the grid scale on the endoscopic image.(1)A basic test was performed to verify the relationship between the measurement error eM and the tilt angle of the endoscope;and(2)The sizes of three colon polyps were measured using our system during endoscopy.These sizes were immediately measured by scale after their removal.RESULTS:There was no error atα=0°.In addition,the values of eM(mean±SD)were 0.24±0.11 mm(α=10°),0.90±0.58 mm(α=20°)and 2.31±1.41mm(α=30°).According to these results,our system has been confirmed to measure accurately when the tilt angle is less than 20°.The measurement error was approximately 1 mm in the clinical study.Therefore,it was concluded that our proposed measurement system was also effective in clinical examinations.CONCLUSION:By combining simple optical equipment with a conventional endoscope,a quick and accurate system for measuring lesion size was established.     

Trichoblastoma in a Child

Abstract:   A trichoblastoma is a benign adnexal neoplasm composed of follicular germinative cells. It most commonly presents as a solitary nodule on the scalp, face, or perineum and occurs equally in males and females. It is diagnosed most commonly between the fourth and the sixth decades, and it is extremely rare in childhood. To our knowledge there is no prior case report of a primary trichoblastoma occurring outside the setting of a nevus sebaceous of Jadassohn in a child before adolescence. Herein we report a case of trichoblastoma of the right cheek in an 11-year-old Korean girl.     

Synergistic effect between catechin and ciprofloxacin on chronic bacterial prostatitis rat model

Abstract Background: Chronic bacterial prostatitis (CBP) is the most common urological disease in adult men. Antibiotic therapy is the gold standard of treatment. However, long‐term therapy resulted in many side‐effects and bacterial resistance. Because of these reasons, we need new treatment modality that could replace traditional antibiotic therapy. Catechin, an extract of green tea, has antimicrobial effect against various bacteria and synergy effect to antibiotics. We evaluate the synergistic effects of catechin on the treatment of CBP in an animal model. Methods: An experimental CBP model was induced in 70 male Wistar rats by instillation of 0.2 mL bacterial suspension (E‐coli Z17, O2:K1:H‐) containing 1 × 108 CFU/mL into the prostatic urethra. Microbiologically and histologically proven CBP model was demonstrated in 58.6% (41 of 70) of the rats after 4 weeks of bacterial instillation. The 41 rats demonstrating CBP were randomly divided into four groups; the control, catechin, ciprofloxacin and catechin with ciprofloxacin groups. All drug treatments were conducted over a period of 2 weeks. After treatment, the results were analyzed with microbiological cultures and histological findings of the prostate and urine samples to compare each group. Results: Microbiological cultures and histological findings of the prostate and urine samples demonstrated reduced bacterial growth and improved inflammatory responses in all three experimental groups compared with the control group. The catechin group showed coherent trends of decrease in bacterial growth and improvements in prostatic inflammation compared with the control group, but not to a statistically significant degree (P > 0.05). However, the ciprofloxacin and catechin with ciprofloxacin groups showed statistically significant decreases in bacterial growth and improvements in prostatic inflammation compared with the control group (P < 0.05). The catechin with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvements in prostatic inflammation compared with the ciprofloxacin group (P < 0.05). Conclusions: These results suggest that catechin may be an effective material in CBP treatment. Particularly, combination treatment of catechin and ciprofloxacin has synergistic effect. Therefore, we suggest that the combination of catechin and ciprofloxacin may be effective in treating CBP with a higher success rate.     

Cold abscess of the chest wall as an unusual complication of BCG vaccination.

Bacillus-Calmette-Guérin (BCG) vaccination often results in local adverse effects; however, serious or long-term complications are rare. The involvement of sternum among skeletal BCG osteomyelitis is a rarely seen complication of BCG vaccination. Such a complication may confuse with a chest wall tumor and a surgical intervention may be needed for the definite diagnosis. A 9-month-old infant who had a parasternal cold abscess in the anterior chest wall and sternal osteomyelitis of tuberculosis in the late period of BCG vaccination of whom the etiological diagnosis was histopathologically confirmed after surgery is presented and the preoperative diagnostic problems are discussed.     

The results of therapeutic plasma exchange in patients with severe hyperthyroidism: A retrospective multicenter study

Hyperthyroidism characterized by elevated serum levels of circulating thyroid hormones. The aim of hyperthyroidism treatment is to achieve a euthyroid state as soon as possible and to maintain euthyroid status. However, drug withdrawal and utilization of alternative therapies are needed in cases in which leucopenia or impairment in liver functions is observed during medical therapy. In the present study, we aimed to present our cases which underwent therapeutic plasma exchange (TPE) due to severe hyperthyroidism. The results of 22 patients who underwent therapeutic plasma exchange due to hyperthyroidism in Apheresis Units of Erciyes University and Gaziantep University, between 2006 and 2012, were retrospectively reviewed. These cases had severe thyrotoxic values despite anti-thyroid drug use. After TPE, we observed a significant decrease in free thyroxin (FT4) (p < 0.001) and free triiodotyhronin (FT3) (p < 0.004) levels. There was statistically significant increase in the mean values of TSH levels after TPE (p < 0.001).Clinical improvement was achieved in hyperthyroidism by TPE in 20 cases (91%). Both FT3 and FT4 levels remained above the normal limits in two of 22 patients. TPE should be considered as an effective and safe therapeutic option to achieve euthyroid state before surgery or radioactive iodine treatment. TPE is a useful option in cases with severe hyperthyroidism unresponsive to anti-thyroid agents and in those with clinical manifestations of cardiac failure and in patients with severe adverse events during anti-thyroid therapy.     

Identification of Key Cost Generating Events for Idiopathic Pulmonary Fibrosis: A Systematic Review

Background

Idiopathic pulmonary fibrosis (IPF) is an incurable, debilitating disease which impairs lung function and eventually leads to death. Currently, there is a lack of effective modifying therapies and treatments for IPF as the underlying epidemiological mechanism is not clearly understood. This leads to difficulty in diagnosing and managing IPF, which results in a high incurment of disease-associated cost. Even though IPF poses a substantial economic burden, there is a lack of research available on cost triggers and healthcare utilization, which can be a barrier to future economic evaluations of new medicines for IPF.

Objectives

We aimed to conduct a systematic literature review (SLR) to identify the key cost-generating events of IPF and to gather any related costing information.

Results

The data showed that the main events triggering high resource use in patients were the symptoms of IPF progression along with comorbidities and lung transplantations. These events result in a high economic impact through the use of medications, health care professionals, and hospital stays.

Conclusion

More research is needed to identify the direct, and indirect, relationships between IPF events and the costs they generate. This would help to further evaluate the area of need for future health technologies and to understand what events should be targeted to reduce the global economic burden of IPF.

     

Magnetic Resonance Imaging of Pulmonary Embolism: Diagnostic Accuracy of Unenhanced MR and Influence in Mortality Rates

Objectives

We evaluated the diagnostic value for pulmonary embolism (PE) of the True fast imaging with steady-state precession (TrueFISP) MRI, a method that allows the visualization of pulmonary vasculature without breath holding or intravenous contrast.

Methods

This is a prospective investigation including 93 patients with suspected PE. All patients underwent TrueFISP MRI after undergoing CT pulmonary angiography (CTPA). Two independent readers evaluated each MR study, and consensus was obtained. CTPA results were analysed by a third independent reviewer and these results served as the reference standard. A fourth radiologist was responsible for evaluating if lesions found on MRI for both analysis were the same and if these were the correspondent lesions on the CTPA. Sensitivity, specificity, predictive values and accuracy were calculated. Evidence for death from PE within the 1-year follow-up was also assessed.

Results

Two patients could not undergo the real-time MRI and were excluded from the study. PE prevalence was 22%. During the 1-year follow-up period, eight patients died, whereas PE was responsible for 12.5% of cases. Between patients who developed PE, only 5% died due to this condition. There were no differences between MR and CT embolism detection in these subjects. MR sequences had a sensitivity of 85%, specificity was 98.6% and accuracy was 95.6%. Agreement between readers was high (κ=?0.87).

Conclusions

Compared with contrast-enhanced CT, unenhanced MR sequences demonstrate good accuracy and no differences in the mortality rates in 1 year were detected.