First report of splenic rupture following deep enteroscopy

Splenic rupture is a rare complication of diagnostic and therapeutic gastrointestinal endoscopy procedures.Herein,we report for the first time a case of splenic rupture following therapeutic retrograde double-balloon enteroscopy,which occurred in an 85-year-old man who was treated for recurrent mid-intestinal bleeding that resulted from ileal angioectasia.This patient promptly underwent an operation and eventually recovered.     

Review of small-bowel cleansing scales in capsule endoscopy:A panoply of choices

Evaluation of the quality of small-bowel cleansing is required to assess the reliability of findings in capsule endoscopy(CE). Moreover, consensus regarding the need of intestinal preparation for CE remains to be achieved. The presence of multiple grading scales for smallbowel preparation in CE, which are time-consuming and complicated, adds difficulty to the comparison of different small-bowel cleansing regimens and their application in clinical practice. Nowadays, a validated scale universally accepted for grading small-bowel cleansing is lacking. In fact, there are numerous grading systems with very different technical characteristics, namely, the parameters and the portion of the CE video that are analyzed, the objectivity of the analysis, the lesser or greater dependency on the operator, and the validation of the score. The authors performed a review which aims to systematize and summarize currently available smallbowel grading scales in CE.     

Device-assisted enteroscopy: A review of available techniques and upcoming new technologies

The advent of video capsule endoscopy into clinical routine more than 15 years ago led to a substantial change in the diagnostic approach to patients with suspected small bowel diseases, often indicating a deep enteroscopy procedure for diagnostical confirmation or endoscopic treatment. Device assisted enteroscopy was developed in 2001 and for the first time established a practicable, safe and effective method for evaluation of the small bowel.Currently with double-balloon enteroscopy, single-balloon enteroscopy and spiral enteroscopy three different platforms are available in clinical routine.Summarizing, double-balloon enteroscopy seems to offer the deepest insertion depth to the small bowel going hand in hand with the disadvantage of a longer procedural duration. Manual spiral enteroscopy seems to be a faster procedure but without reaching the depth of the DBE in currently available data. Finally,single-balloon enteroscopy seems to be the least complicated procedure to perform. Despite substantial improvements in the field of direct enteroscopy,even nowadays deep endoscopic access to the small bowel with all available methods is still a complex procedure, cumbersome and time-consuming and requires high endoscopic skills. This review will give an overview of the currently available techniques and will further discuss the role of the upcoming new technology of the motorized spiral enteroscopy(PowerSpiral).     

HPLC法测定柴香疏肝胶囊中芍药苷的含量

目的 采用高效液相色谱法测定柴香疏肝胶囊中芍药苷的含量。方法 采用高效液相色谱法,色谱柱为InertSustain C18柱(4.6mm×150 mm,5 μm),以乙腈-0.1%磷酸溶液(14∶86)为流动相,流速为1.0 mL/min,检测波长为230nm。结果 芍药苷的线性范围为0.1172～2.344 μg(r=0.9999),芍药苷平均加样回收率为99.05%,RSD为2.08%。结论 高效液相色谱法可以用于柴香疏肝胶囊中芍药苷的含量测定。     

Diagnosis of Ascaris lumbricoides infection using capsule endoscopy

Ascaris lumbricoides (A. lumbricoides ) is the most common intestinal roundworm parasite, infecting approximately one quarter of the world’s population. Infection can lead to various complications because it can spread along the gastrointestinal tract. Although A. lumbricoides infection is a serious healthcare issue in developing countries, it now also has a worldwide distribution as a result of increased immigration and travel. Intestinal obstruction is the most common complication of A. lumbricoides infection, potentially leading to even more serious consequences such as small bowel perforation and peritonitis. Diagnosis is based primarily on stool samples and the patient’s history. Early diagnosis, aided in part by knowledge of the local prevalence, can result in early treatment, thereby preventing surgical complications associated with intestinal obstruction. Further, delay in diagnosis may have fatal consequences. Capsule endoscopy can serve as a crucial, non-invasive diagnostic toolfor A. lumbricoides infection, especially when other diagnostic methods have failed to detect the parasite. We report a case of A. lumbricoides infection that resulted in intestinal obstruction at the level of the ileum. Both stool sample examination and open surgery failed to indicate the presence of A. lumbricoides, and the cause of the obstruction was only revealed by capsule endoscopy. The patient was treated with anthelmintics.     

A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy

Background: Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD).

Aim: The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings.

Patients and methods: Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD.

Results: Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p?=?.048). Median calprotectin and lactoferrin in the CD group and in the control group were 169?mg/kg vs. 40 (p?=?.004) and 6.6?mg/kg vs. 1 (p?=?.051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95?mg/kg and fecal lactoferrin of 1.05?mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD.

Conclusions: Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE.

ClinicalTrials.gov Identifier: NCT01266629     

固环胶囊对宫内节育器大鼠血浆及子宫组织内皮素含量的影响

目的研究固环胶囊治疗宫内节育器致出血副反应的疗效及其作用机理。方法对宫内节育器大鼠模型灌服固环胶囊,10 d后取血和子宫组织,检测内皮素的含量。结果固环胶囊有升高宫内节育器大鼠模型血浆及子宫组织内皮素的作用,与模型组比较有显著性差异(P<0.05)。结论固环胶囊可能通过调节机体内皮素的含量而收缩血管,减少子宫局部血流量,从而达到治疗置器后月经过多、经期延长的目的。     

乳痛安胶囊治疗冲任失调型乳腺增生病疗效观察

目的：观察乳痛安胶囊治疗乳腺增生病冲任失调型的临床疗效。方法：将乳腺外科门诊确诊的乳腺增生病证属冲任失调型女性患者60例随机分为两组。治疗组30例采用乳痛安胶囊口服,对照组30例口服安慰剂胶囊,疗程均为2个月。结果：治疗组痊愈2例,显效12例,有效13例,无效2例,脱落1例,总有效率为93.10%;对照组显效2例,有效8例,无效19例,其中脱落1例,总有效率为34.48%。乳房局部症状和全身症状治疗前后比较均有显著差异（P〈0.01）。结论：乳痛安胶囊治疗冲任失调型乳腺增生病有较好的临床疗效。     

胶囊内镜在消化道疾病检查中的应用价值

目的探讨胶囊内镜对消化道疾病的诊断价值。方法对179例消化道疾病患者及健康查体者行胶囊内镜检查。结果胶囊内镜显示病变148例(82.7%),其中小肠血管畸形72例,克罗恩病12例,小肠良性狭窄3例,增生性病变6例,胃肠息肉31例,末端回肠炎10例,小肠肿瘤9例,十二指肠溃疡11例,胆汁反流性胃炎25例;31例无阳性发现。检查过程中患者无不适及并发症。结论胶囊内镜对胃及小肠病变检出率高,可作为不明原因消化道出血或长期腹泻、腹痛患者的常规检查。