Rate and yield of repeat upper endoscopy in patients with dyspepsia

AIM: To determine the rate and yield of repeat esophagogastroduodenoscopy (EGD) for dyspepsia in clinical practice,whether second opinions drive its use,and whether it is performed at the expense of colorectal cancer screening.METHODS: We performed a retrospective cohort study of all patients who underwent repeat EGD for dyspepsia from 1996 to 2006 at the University of California,San Francisco endoscopy service.RESULTS: Of 24 780 EGDs,5460 (22%) were performed for dyspepsia in 4873 patients.Of these,451 patients (9.3%) underwent repeat EGD for dyspepsia at a median 1.7 (interquartile range,0.8-3.1) years after initial EGD.Signif icant f indings possibly related to dyspepsia were more likely at initial (29%) vs repeat EGD (18%) [odds ratio (OR),1.45;95% confidence interval (CI): 1.20-1.75,P < 0.0001],and at repeat EGD if the initial EGD had reported such f indings (26%) than if it had not (14%) (OR,1.32;95% CI: 1.08-1.62,P = 0.0015).The same endoscopist performed the repeat and initial EGD in 77% of cases.Of patients aged 50 years or older,286/311 (92%) underwent lower endoscopy.CONCLUSION: Repeat EGD for dyspepsia occurred at a low but substantial rate,with lower yield than initial EGD.Optimizing endoscopy use remains a public health priority.

The Question of Short Lower Limb and Long Lower in Manual Therapy: An Overview

The purpose of this paper is to review relevant literature concerning limb length inequalities in adults and to make recommendations for assessment and intervention based on the literature and our own clinical experience. The research was carried out on PUB MED, Non-English articles and duplicates in the databases were not included. Limb length inequality and common classification criteria are defined and etiological factors are present. Common methods of detecting limb length inequality include model manual technics. This work has the purpose of describing a well standardized therapeutic in the form of practical guidance. The approach we describe provides standardized model evaluation for leg lower limb in order to be used in rehabilitation clinic.

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）. METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）. RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.