1,720,971 research outputs found
Evaluation of hands-on training in colonoscopy : is a computer-based simulator useful?
No full textBACKGROUND AND AIMS:The advantages of using a computer-based simulator during colonoscopy training are debated. We aimed to explore its usefulness in objectively measuring trainees' competence in colonoscopy.
METHODS: Twelve colonoscopy trainees (fully trained in upper GI endoscopy) were evaluated using a computer-based simulator (GI-Mentor, Symbionix) before and during hands-on training (i.e. after 60 colonoscopies); the controls were 15 experts (>90% of caecal intubation). Both trainees and experts performed two "screening" simulations (easy and difficult) in a randomised order, and the time to reach the caecum and withdrawal time was assessed.
RESULTS: The percentage of caecal intubation progressively increased during hands-on training. All of the trainees intubated the caecum during the easy and difficult simulations, both before and during hands-on training. The median time (interquartile range) to reach the caecum upon easy simulation was the only variable influenced by hands-on training: 2.7min (2.1-3.2) before and 1.9min (1.6-2) during training (p<0.01). Withdrawal time was ≥6min in the case of five trainees before training, and three during hands-on training. Computer-based simulator performance did not correlate with hands-on training performance.
CONCLUSIONS: The computer-based simulator was not found to be useful in evaluating competence during hands-on training in colonoscopy
Severe chronic diarrhea and maculopapular rash : a case report
No full textSystemicmastocytosis (SM) is a heterogeneous disease of the bone marrow characterized by abnormal growth,accumulation and activation ofclonal mastcells (MCs). We reporta case of SM with multi-organ involvement. A 30-year-old man presented with diarrhea, flushing, maculopapular rashwithitching and weightloss. The upper and lower gastrointestinal endoscopies showed macro scopic involvement of stomac hand duodenum; mucosal samples fromstomach, duodenum, colon and distal ileum showed mucosal infiltration by large, spindle-shaped MCs with abnormal surface molecule expression (CD2 and CD25), a picture fully consistent with SM, according to the World Health Organization diagnostic criteria. A computed to mography scan showed diffuse lymphadenopathy, hepatosplenomegaly and diffuse small bowel involvement. Bone marrow aspirate and biopsy were diagnosticfor SM; serumtryptase levels were increased (209 ng/mL, normal values < 20 ng/mL). The conclusive diagnosis was smouldering SM. There were no therapeuticindications except for treatment of symptoms. The patient was strictly followed up because of the risk of aggressive evolution
Can biliary endoscopy play a role in liver disease associated to cystic fibrosis?
No full textBiliopathy associated to cystic fibrosis (CF) is a relatively rare condition in adult patients. Recently, an increase in life expectancy for patients with cystic fibrosis (CF) has been reported. Therefore, a new clinical picture related to CF- associated liver involvement is quite often observed [1]. The involvement of the biliary tree has been hypothesized as having a pivotal role in the pathogenesis and evolution of liver cirrhosis, but there is a lack of systematic data about it [1,2]. The impact of endotherapy on the biliopathy and liver disease in adult cystic fibrosis patients needs sistematic evaluation with a long-term follow-up
Usefulness of low- and high-volume multiple rapid swallowing during high-resolution manometry
No full textBACKGROUND: It has been suggested that multiple rapid swallowing should be added to oesophageal manometry.
AIM: To prospectively evaluate whether 10 and 200mL multiple rapid swallowing provide different information concerning motor function.
METHODS: 30 consecutive patients with oesophageal symptoms, 13 achalasia patients after successful pneumatic dilation and 19 healthy subjects performed eight 5mL single swallows, two 10mL and one 200mL multiple rapid swallowing.
RESULTS: Almost all of the healthy subjects and two-thirds of the patients with oesophageal symptoms showed motor inhibition during both 10 and 200mL multiple rapid swallowing. The oesophago-gastric pressure gradient was significantly higher during 200mL multiple rapid swallowing within each group (p<0.01), and significantly higher in the achalasia patients than in the other two groups (p<0.0001). Presence of a contraction and increased contraction strength in comparison with single swallows were both more frequent after 10mL than after 200mL multiple rapid swallowing in the healthy subjects and the patients (p<0.05).
CONCLUSION: Motor inhibition could be similarly evaluated by means of 10 and 200mL multiple rapid swallowing; 10mL evaluated the after-contraction, whereas 200mL multiple rapid swallowing was more valuable in identifying increased resistance to outflow
Use of a computer simulator to evaluate a residency program of hands-on-training in colonoscopy
No full textRelazione tra erosione dentale e reflusso gastro-esofageo
No full textLo scopo di questo lavoro è quello di valutare l’associazione tra disturbo da reflusso gastro-esofageo (GERD) ed erosione dentale, già nota in letteratura, ma priva di linee guida o studi mirati al corretto approccio preventivo e terapeutico nei confronti di questi pazienti
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
pH Impedance vs. traditional pH monitoring in clinical practice : an outcome study
No full textBackground The addition of impedance to 24-h pH monitoring has allowed detection of weakly acidic reflux, but the extent to which pH-impedance (pH-MII) monitoring improves outcomes is unknown.
Methods This was a prospective observational study. Patients referred for pH or pH-MII monitoring completed a standardized questionnaire on improvement in the dominant symptom, their satisfaction, and treatment at 3 and 12 months after the test during a telephone interview.
Results A total of 184 patients (mean age, 52 years, range, 19–82 years; 35 % with typical symptoms; and 89 % tested off therapy) completed pH (n = 92) or pH-MII
monitoring (n = 92) over a period of 15 months. The two arms were similar in terms of demographic, clinical, and endoscopic variables. Ten patients in the pH-MII arm
showed evidence of weakly acidic reflux disease. There was no difference in the percentage of patients in the pH and pH-MII monitoring arms who experienced improvement in their dominant symptom after 3 (58 vs. 63 %; p = 0.621) or 12 months (66 vs. 70 %; p = 0.234), and the same was true for patient satisfaction. There were also no between-group difference in the use of proton pump inhibitors (PPIs) after 3 (63 vs. 68.5 %; p = 0.437) or 12 months (47 vs. 60.5 %; p = 0.051). PPIs were prescribed more frequently after a positive test (p\0.001) although they were used by 45.6 % of the negative patients. Only one patient underwent fundoplication.
Conclusions Two-thirds of patients undergoing pH-MII monitoring experience a positive outcome, similarly to what occurs after traditional pH monitoring. Physicians often pay little attention to the test results, especially if they
are negative
- …
