Gastric cancer missed at endoscopy

Stomach cancer is the fourth most common malignancy worldwide. Endoscopy (with biopsies) is the gold standard for its diagnosis but missed oesophageal and gastric cancers are not infrequent in patients who have undergone previous endoscopy. Errors by the endoscopist account for the majority of these missed lesions. The following report describes an incident in which there was a diagnostic error that led to a failed diagnosis of gastric cancer at first endoscopy. The implications for clinical and endoscopic practice are discussed.Keywords: Gastric cancer; Misdiagnoses; Diagnostic error; Endoscop

Network-aware design-space exploration of a power-efficient embedded application

The paper presents the design and multi-parameter optimization of a networked embedded application for the health-care domain. Several hardware, software, and application parameters, such as clock frequency, sensor sampling rate, data packet rate, are tuned at design- and run-time according to application specifications and operating conditions to optimize hardware requirements, packet loss, power consumption. Experimental results show that further power efficiency can be achieved by considering also communication aspects during design space exploratio

Colorectal cancer in Egypt is commoner in young people: Is this cause for alarm?

Background: Colorectal cancer (CRC) is the third most common cancer worldwide after lung and breast cancers with two-thirds of all CRCs occurring in the more developed regions of the world. CRC affects men and women of all racial and ethnic groups, and is most often found in those aged 50 years or older. Aim: The aim of the study was to determine the prevalence of CRC among patients undergoing colonoscopy in Egypt. Materials and methods: This was a descriptive cross-sectional hospital-based study. A total of 412 consecutive patients who underwent planned pancolonoscopy from January 2000 to January 2012 at our institution were assessed. All endoscopic examinations leading to a diagnosis of CRC were evaluated. The following parameters were analyzed: frequency of CRC, patient characteristics, indication for endoscopic examination, endoscopic findings, localization of CRC and histopathology. Results: CRC was diagnosed in 57 patients (14% of all colonoscopies). Fifty-six percent were female. The mean age was 51± 15 years (age range: 16–80 years). Twenty-five percent of cancers occurred in patients aged less than 40 years. The most frequent indication for colonoscopy was rectal bleeding (39%). The most common colonoscopy finding was mass (96%). Sixty-eight percent of CRC were located in the left colon and rectum. Ninety-one percent of CRC wereAdenocarcinoma. Conclusions: CRC is not uncommon among Egyptian patients subjected to colonoscopy. Thereare relatively higher CRC rates in patients under 40 years of age than reported in the West. This has implications relating to future epidemiological trends in Egypt. Physicians must have a greater awareness of the potential for CRC in young people in the Middle East.Keywords: Colorectal cancer; Birth cohort; Egypt 

Prevalence of reflux esophagitis among patients undergoing endoscopy in a secondary referral hospital in Giza, Egypt

Background: Gastro-esophageal reflux disease (GERD) is one of the most prevalent diseases seen in western countries. The prevalence of GERD is lower in the Asian population and the spectrum of the disease is mild. Data from Africa and the Middle East are sparse.Aim: The aim of the study was to determine the prevalence, severity and risk factors of reflux esophagitis (RE) among patients undergoing endoscopy in a secondary referral hospital in Egypt.Materials and methods: This was a retrospective study. Data on patients presenting with gastroesophageal reflux symptoms (RS) and scheduled for upper gastrointestinal endoscopy between January 2000 and January 2013 were collected.Results: Four hundred and thirty-three patients were assessed. Two hundred and fifty-four (59%) were male. Ages ranged from 18 to 85 years, mean 45± 15 years. One hundred and forty-four patients (33%) had a history of smoking, 120 (28%) were taking aspirin or non-steroidal anti-inflammatory drugs and 8 (2%) were consuming alcohol. The duration of RS ranged from one month to 20 years, mean 21 ± 30 months. One hundred and forty-six patients (34%) had the RS daily, 70 (16%) classified RS as severe intensity and 99 (23%) had acid regurgitation. One hundred and six patients (24%) were found to have RE. Ninety-eight of them (23%) showed grade 1. Barrett’s esophagus (BE) was diagnosed in seven patients (2%) and esophageal stricture in one (0.2%). One hundred and four patients (24%) had hiatus hernia (HH), 16 (4%) gastric ulcers and 45 (10%) duodenal ulcers. In multivariate analysis, male sex and HH were two independent risk factors for the development of RE.Conclusion: The prevalence of RE is low among patients undergoing endoscopy. Most of the patients had a mild degree of esophagitis. BE and stricture were rarely seen. Male sex and HH were risk factors of RE

Improving the quality of endoscopic polypectomy by introducing a colonoscopy quality assurance program

Background: Colonoscopy is a routine procedure in patients who present with bowel symptoms. Polyps can be identified and removed during colonoscopy. A colonoscopy quality-assurance program (CQAP) was instituted in 2003.Aim: The aim of the study was to determine the effect of instituting a CQAP on the quality of endoscopic polypectomy (EP) in our patients.Patients and methods: An Initial assessment of EP practice in 2003 showed that four patients had polyps. Cecal intubation had been achieved in only two patients and a complete polyp description (CPD) had not been documented. Polypectomy was performed in two patients but the completeness of removal and retrieval of the polyps had not been assessed and histology had not been recorded. A quality improvement process was therefore instituted. This required full colonoscopy to the cecum, CPD and polypectomy to be performed for every polyp. There should be a 90% retrieval rate of all excised polyps and follow up of all histology reports. Seventy-six patients were assessed prospectively over the period 2004–2011.Results: Cecal intubation rates increased from 65% in years 2004–2007 to 90% in years 2008–2011 (t-proportion = 2.4 & CI= 4.7, highly significant). CPD rates increased from 35% to 100% (t-proportion = 6.5 & CI= 12.7,  highly significant). EP rates increased from 59% to 100% (t-proportion = 3.5 & CI= 6.9, highly significant). Percentage of procedures in which all polyps were judged completely removed increased from 41% to 86% (t-proportion = 3.6 & CI= 7, highly significant). Polyp retrieval rates, with retrieval of P90% of all excised polyps, increased from 80% to 92% (t-proportion = 0.87 & CI= 1.7, significant). Polyp histology documentation rates increased from 41% to 88% (t-proportion =3.7 & CI= 7.3, highly significant).Conclusion: The implementation of a quality assurance and improvement program improved the quality of EP in patients with polyp(s) detected during colonoscopy.Keywords: Colonoscopy; Polypectomy; Quality assurance; Juvenile polyp

Infectivity of Cryptosporidium parvum genotype I in conventionally reared piglets and lambs

Parasites of the genus Cryptosporidium are intracellular parasites that occur throughout the animal kingdom and have been reported in many species of mammals, including human. Most infections in humans are caused by two C. parvum genotypes, genotype I and genotype II; these are the human and the bovine (zoonotic) genotypes, respectively. Successful experimental infection of Cryptosporidium parvum genotype I "human genotype" is described in four conventionally reared piglets and in a lamb. The inoculum was originally obtained from two diarrheic children, and the Cryptosporidium genotypes were determined by PCR and rDNA sequencing. The infective dose was between 106 and 2×106oocysts. No clinical signs were observed in the infected animals, except in a piglet that showed watery diarrhea. The oocyst shedding period in positive animals ranged between 4 and 10 days. Histopathologic examination of the gastrointestinal tract of two positive piglets revealed shortening of the villi and denudation of the villous tips of the jejunum. In one piglet, the colon mucosa revealed numerous Cryptosporidium oocysts. The storage time of the inocula (≤3 weeks in PBS at 4°C) and the age of the animal (newborn) were important for the successful induction of infectio

Pyloromyotomy for infantile hypertrophic pyloric stenosis using a modification of the Tan and Bianchi circumumbilical approach

Background/purpose Different approaches have been advocated for pyloromyotomy.  Since the introduction of umbilical pyloromyotomy, a number of studies have shown that it is as safe as the traditional right upper quadrant approach with superior  cosmetic results. The aim of this study was to assess the feasibility and the safety  of pyloromyotomy for infantile hyprtrophic pyloric stenosis using a modification of the Tan–Bianchi approach.Patients and methods Over a period of 2 years, 20 infants with infantile  hypertrophic pyloric stenosis have been clinically evaluated. The umbilical approach was modified so that a transverse muscle cutting incision rather than a longitudinal midline linea alba incision was performed.Results The total number of cases included in this study was 20 [16 male (80%)  and four female (20%) patients]. Their ages ranged from 23 to 60 days (average  42.6 ±13.54 days), and their weights ranged from 2700 to 4000 g (mean 3605± 437.4 g). Pyloromyotomy was performed safely with negligible blood loss. Four cases of serosal tear occurred, with an incidence of 20%. None of our cases showed significant complications. The mean operating time was 52.5 ± 5.073 min. The postoperative hospital stay ranged from 24 to 72 h. The postoperative course was uneventful in all patients, and, on follow-up, the circumumbilical incision left an almost undetectable scar.Conclusion Pyloromyotomy for infantile hypertrophic pyloric stenosis using the modified Tan and Bianchi technique is feasible and safe, having an accepted operative time, early initiation of postoperative feeding, and short hospital stay. This modification combines the advantage of circumumbilical incision with its better cosmetic results and right transverse upper abdominal approach with its easy and feasible access to the pyloric mass.Keywords: operative intervention, pyloric stenosis, Tan–Bianchi approac

Use of Balloon-Expandable Stents for Coarctation of the Aorta: Initial Results and Intermediate-Term Follow-Up

AbstractObjectives. In this study we report our preliminary results and intermediate-term follow-up (up to 3.5 years) of stent implantation for coarctation of the aorta (COA).Background. Balloon angioplasty has gained acceptance as a modality of treatment for COA. Some patients do not respond optimally to balloon angioplasty alone. Balloon-expandable stents have been used in pulmonary arteries and large systemic arteries such as the femoroiliac vessels, with a significant improvement in vessel patency and a reduction in the pressure gradient compared with balloon angioplasty alone.Methods. Nine patients (>10 years old) with COA in whom balloon dilation alone was thought to be ineffective underwent stent implantation. Seven patients had a previous operation or balloon dilation, or both, to relieve their coarctation but had a significant residual/recurrent gradient.Results. At the time of stent implantation, the systolic and mean gradients decreased from a mean (±SEM) of 37 ± 7 and 14 ± 3 mm Hg to 4 ± 1 and 2 ± 0.6 mm Hg, respectively (p ≤ 0.002). The coarctation diameter increased from a mean of 9 ± 1 to 15 ± 1 mm (p < 0.002). The patients have been followed for up to 42 months (mean 18, median 13) with no complications; the stents remain in position with no fracture. One patient underwent further successful dilation 3 years after stent implantation because of an exercise-induced gradient. No other intervention has been required. The systolic gradient at latest follow-up is 7 ± 2 mm Hg. Only two (a 44-year old with diabetes and a 50-year old with long-standing hypertension) of five patients previously requiring antihypertensive treatment still remain on medications for blood pressure control.Conclusions. The use of stents in COA is a feasible alternative to surgical repair or balloon angioplasty in selected patients with an effective gradient reduction. Intermediate-term follow-up shows excellent gradient relief, with no complications in this group of patients

Optimization of EDM process parameters for Al-SiC reinforced metal matrix composite

Volume 8 Issue 2 (February 201