Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.     

Idiopathic Headache as a Possible Risk Factor for Phantom Tooth Pain

Following tooth pulp extirpation, some subjects suffer from persistent pain which affects edentate sites in absence of any local pathology. As regards this peculiar pain, called phantom tooth pain (PTP), what is puzzling is the fact there is a low prevalence of PTP in a very large population showing identical conditions of tooth pulp extirpation. The present investigation indicates that PTP mainly affects migraine (M) and cluster headache (CH) sufferers, whereas it does not affect subjects who have a negative personal and family history for idiopathic headache (IH). These results circumscribe the presence of PTP to a specific section of the population. The present results, besides indicating that PTP may be the result of a peculiar neuronal predisposition relating to IH pathogenesis, suggests some practical therapeutic hints. In fact, successful anti- M and anti-CH prophylactic treatment greatly improve PTP syndrome.     

Continuous mixed venous oximetry in critically ill surgical patients. 'High-tech' cost-effectiveness

Mixed venous oxygen saturation (Svo2) provides a measure of cardiorespiratory ability to meet the body's needs for oxygen. The Svo2 was measured continuously in 20 critically ill surgical patients using a pulmonary-artery oximetry system. The accuracy of the technique was validated by comparing initial continuous Svo2 to the laboratory determination of Svo2. Oximetry was used to guide therapeutic decisions regarding fluid, inotropic agents, vasodilators and ventilator setting and was useful in ten cases. Sepsis developed in nine patients; this severely limited the usefulness of the technique. With clinical decision making based on oximetry, there was a savings per catheter of 2.65 cardiac output determinations and 5.9 venous blood gas determinations, resulting in a net savings per catheter of +75.