微生物镜检诊断在氧化沟工艺运行中的指导作用

通过对氧化沟工艺曝气池的生物镜检诊断,了解该工艺正常运行时的优势生物种属,以及曝气池环境变化时相应的生物镜检的变化。根据镜检诊断调整工艺运行参数,使微生物的生长趋于良性,确保运行稳定,出水达标排放。

免疫快速诊断卡检出疟原虫感染的准确性荟萃分析

目的了解既往评价RDTs产品诊断疟疾的质量状况和准确性置信程度。方法在Medline、PubMed、EMBASE、Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库检索有关评价RDTs诊断疟疾准确性的文献,排除不满足要求的文献,按2×2四格表形式提取敏感性、特异性数据,采用Review Manger 5.3.1软件进行RDTs诊断疟疾准确性分析,获得森林图和SROC曲线,对所有纳入研究用QUADAS-2工具进行方法学质量评估。结果共43篇以镜检法作为金标准的RDTs诊断恶性疟、间日疟准确性的文献被纳入分析,其中中文文献17篇,方法学质量评价中"病例选择"、"待评试验"、"金标准"、"病例流程和进展情况"偏倚风险为LR、UR、HR的比例分别是0、0、100%,53%、6%、41%,47%、53%、0和35%、47%、18%;英文文献26篇,上述偏倚风险为LR、UR、HR的比例分别是27%、15%、58%,77%、19%、4%,100%、0、0和50%、27%、23%。分析显示,中、英文文献中RDTs诊断恶性疟的阳性样品中位数分别为99和167,最低敏感性、特异性分别为67%、84%和55%、52%,中文文献的合并敏感性、特异性高于英文文献,最低合并值来自英文文献;中、英文文献中RDTs诊断间日疟的阳性样品中位数分别为59和69,最低敏感性、特异性分别是38%、84%和52%、65%,中文文献的合并敏感性、特异性高于英文文献。结论 RDTs作为替代镜检法诊断疟疾的手段具有一定实用性,但由于忽视研究设计和样本量控制,中文文献报道的RDTs诊断疟疾的准确性置信度低于英文文献。

A Comparison between biopsy and brilliant blue chromo -endoscopy in gastric cancer

AIMS To increase the discovering rate of early gastric cancer and the positive rate of biopsy,the brilliant blue(BB)chromo-en- doscopy and the routine endoscopy were used to examine 54 pa- tients with gastric cancer. METHODS BB staining method and steps:Othe examinee was injected IM 20 mg of Anisodamini Hydromidum;②he took a cup of BB solution;③after 40-60 min he was examined with the endoscope.All of the examinee were also examined with the rou- tine endoscope. RESULTS Sixteen of 54 patients were demonstrated to suffer from early gastric cancer,the detecting rate of early cancer being 29.4%.Among these,15 cases were discovered by BB endoscopy,and only 5 cases by the routine endoscopy.The for- mer is more sensitive in discovering early gastric cancer than the latter(P<0.01)o In addition,the BB endoscopy increases the positive rate of biopsy from 70.4%(38/54)to 94.4%(51. 54),which is clearly supperior in the diagnosis of gastric can- cer to that by routine endoscopy(P<0.01). CONCLUSIONS The BB chromo-endoscopy is more useful in following up the gastric precancerous lesion than the routine endoscopy.

自发性食管下段黏膜剥离窦道形成误诊为食管静脉曲张1例

一、病历摘要 患者男性,40岁.因呕血、黑便11d入院.缘于11天前正常进食后半小时突发呕血1次,量约100 ml,随后黑便1次而住某医院,电子胃镜示:"食管中下段距门齿30 cm以下前壁一条曲张静脉,直径约3 mm,呈青蓝色,曲张静脉表面黏膜局部可见红斑,黏膜縻烂."临床诊断为"食管静脉曲张破裂出血".经禁食、止血、制酸等治疗,未再呕血、黑便.为行静脉曲张内镜下治疗来我院.

Therapeutic procedures for submucosal tumors in the gastrointestinal tract

This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However, benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor, imatinib.

Review of endoscopic techniques in the diagnosis and management of cholangiocarcinoma

Cholangiocarcinoma is a rare malignancy of the biliary tract. Key factors in determining therapeutic options include knowledge of tumor extent, anatomy and obtaining tissue diagnosis. Endoscopically, there are three modalities available to make the diagnosis of cholangiocarcinoma. These include endoscopic retrograde cholangiopancreatography, endoscopic ultrasound with fine needle aspiration and cholangioscopy. Management of cholangiocarcinoma endoscopically is typically confined to stent placement for palliative purposes or as a bridge to surgery. In this article, we will review the endoscopic techniques available for the diagnosis and management of cholangiocarcinoma.

How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions?

AIM： To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. METHODS： Capsule endoscopic （CE） examination by using M2A capsule endoscope TM （Given Imaging, Yoqneam, Israel） was performed in thirty nine patients （26 males, 13 females） with suspected small intestinal lesions. The composing of the patients was as follows： obscure gastrointestinal bleeding in twenty three patients, known Crohn＇s disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin. RESULTS： In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding （73.9%）. Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn＇s disease, CE revealed better evaluation of the disease extension. In 3 of 8 （37.5%） patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal. CONCLUSION： In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn＇s disease.

Clinical significance of type V_I pit pattern subclassification in determining the depth of invasion of colorectal neoplasms

AIM: To clarify whether subclassification of the type VI pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms.METHODS: We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type VI, n = 202; type VN, n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type VI pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth.RESULTS: One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 μm (SM < 1000 μm). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 μm (SM ≥ 1000 μm). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 μm than in lesions with SM ≥ 1000 μm (P < 0.01).CONCLUSION: Subclassification of the type VI pit pattern is useful for identifying dysplasias or lesions with SM < 1000 μm.

The future of wireless capsule endoscopy

We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett's and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.

Capsule endoscopy in celiac disease

Video capsule endoscopy is an attractive and patient- friendly tool that provides high quality images of the small bowel. Obscure gastrointestinal bleeding is the primary and most evaluated indication to capsule endoscopy;however,indications are expanding and a small number of preliminary reports have been presented concerning the role of video capsule endoscopy in the diagnosis of celiac disease. The purpose of this review is to update the current knowledge and to hypothesize on future perspectives of the use of video capsule endoscopy in patients with celiac disease.

Application of laparoscopy in diagnosis and treatment of massive small intestinal bleeding: Report of 22 cases

AIM: To investigate the diagnostic and therapeutic value of laparoscopy in patients with massive small intestinal bleeding. METHODS: Twenty-two patients with massive small in- testinal bleeding and hemodynamic alteration underwent laparoscopic laparotomy in our unit from December 2002 to April 2005. Post pathologic sites were found, laparos- copy- or laparoscopy-assisted part small intestinal resec- tion including pathologic intestinal site and enteroanas- tomosis was performed in all these patients. RESULTS: The bleeding sites were successfully detected by laparoscopy in all these 22 patients. Massive small intestinal bleeding was caused by jejunum benign stromal tumor in 8 cases, by jejunum potential malignant stromal tumor in 5 cases, by jejunum malignant stromal tumor in 1 case, by Mechel’s diverticulum in 5 cases, by small intestinal vascular deformity in 2 cases, and by ectopic pancreas in 1 case. A total of 16 patients underwent laparoscopy-assisted enterectomy and enteroanastomosis of small intestine covering the diseased segment and 6 patients received enterectomy of the diseased segment under laparoscope. No surgical complications occurred and the outcome was satisfactory. CONCLUSION: Laparoscopy in diagnosis and treatment of massive small intestinal bleeding is noninvasive with less pain, short recovery time and definite therapeutic efficacy.

Expanding role of capsule endoscopy in inflammatory bowel disease

Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn's disease. Capsule endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.

Capsule endoscopy in pediatric patients

Wireless capsule endoscope (WCE) for the investigation of the small bowel is an approved technique both in adults and children (more than 10 years old). The present review provides data on the indications, diagnostic yield, adverse events and limitations of the WCE technique in children and tries to predict the future of WCE usage in this population of patients.

Endoscopic treatment of chronic pancreatitis

Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, new improvements were necessary： failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated.

Diagnostic procedures for submucosal tumors in the gastrointestinal tract

This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.

Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

AIM:To review the literature on capsule endoscopy(CE) for detecting esophageal varices using conventional esophagogas troduodenoscopy(EGD)as the standard. METHODS:A strict literature search of studies comparing the yield of CE and EGD in patients diagnosed or suspected as having esophageal varices was conducted by both computer search and manual search.Data were extracted to estimate the pooled diagnostic sensitivity and specificity. RESULTS:There were seven studies appropriate for meta-analysis in our study,involving 446 patients. The pooled sensitivity and specificity of CE for detecting esophageal varices were 85.8%and 80.5%, respectively.In subgroup analysis,the pooled sensitivity and specificity were 82.7%and 54.8%in screened patients,and 87.3%and 84.7%in the screened/ patients under surveillance,respectively. CONCLUSION:CE appears to have acceptable sensitivity and specificity in detecting esophageal varices.However,data are insufficient to determine the accurate diagnostic value of CE in the screen/ surveillance of patients alone.

COMPLICATIONS IN LAPAROSCOPIC GYNECOLOGIC SURGERY

Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (176%). Results. Complications occured in 34 cases, the overall complication rate was 192%. Unintended laparotomies occured in 6 cases(034%). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 353% of all complications of this series. Five intraoperative complications (147%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.

Small bowel capsule endoscopy in 2007:Indications,risks and limitations

Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn＇s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool （which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions）.The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions （i.e. obscure GI bleeding）, the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way （with capsule endoscopy） and to define and treat the lesions identified （with double balloon enteroscopy）.

Diagnostic laparoscopy and laparoscopic ultrasonography withlocal anesthesia in hepatocellular carcinoma

Diagnosis of hepatocellular carcinoma (HCC), a common digestive malignancy, remains a challenge. The aim of this study was to evaluate the feasibility of performing laparoscopy and laparoscopic ultrasound with local anesthesia as a diagnostic procedure in HCC. Laparoscopy and laparoscopic ultrasound with local anesthesia was performed in the gastrointestinal endoscopy unit in three patients diagnosed of HCC. Endoscopy staged diffuse liver disease. Laparoscopic ultrasonography identified all liver tumors not visible during endoscopy and guided needle biopsy in one case. No complications happened. In conclusion, laparoscopy and laparoscopic ultrasound,performed as a minimally invasive diagnostic procedure can be a safe and very promising tool in planning therapy of HCC.

Diagnosis of obscure gastrointestinal bleeding by intraoperative enteroscopy in 81 consecutive patients

AIM： To analyze the results and complications of intraoperative enteroscopy （IOE） by investigating a series of selected patients with bleeding suspected to originate from the small intestine. METHODS： Eighty-one patients （mean age： 65 years） including 40 males （49.4%） and 41 females （50.6%） with obscure gastrointestinal bleeding underwent IOE between 1990 and 2004. The patients were identified from a database and data were selected from the patients＇ charts retrospectively. All the patients had undergone at least one non-diagnostic esophagogastroduodenoscopy, colonoscopy, standard enteroscopy and a negative abdominal ultrasound scan before IOE. RESULTS： The median minimal hemoglobin level in the patients was 59＋15g/L and 72.8% of the patients required transfusion of packed erythrOoltes previously. A bleeding source was detected in 68 （84%） of the patients during IOE. Angiodysplasiae were found in 44 patients （54.3%） and 9 patients （11.1%） were affected by ulcers in the small intestine. A tumor in the small intestine was detected in another 6 patients. The treatment consisted of argon-plasma-coagulation, surgical suture or limited resection in most of the patients. CONCLUSION： Intra-operative enteroscopy is still used for the diagnosis of suspected small bowel bleeding. Recent developments such as wireless capsule endoscopy and double balloon enteroscopy, may lead to the replacement of IOE in the future.