Colon wall motility: comparison of novel quantitative semi-automatic measurements using cine MRI

Background Recently, cine magnetic resonance imaging (MRI) has shown promise for visualizing movement of the colonic wall, although assessment of data has been subjective and observer dependent. This study aimed to develop an objective and semi-automatic imaging metric of ascending colonic wall movement, using image registration techniques. Methods Cine balanced turbo field echo MRI images of ascending colonic motility were acquired over 2 min from 23 healthy volunteers (HVs) at baseline and following two different macrogol stimulus drinks (11 HVs drank 1 L and 12 HVs drank 2 L). Motility metrics derived from large scale geometric and small scale pixel movement parameters following image registration were developed using the post ingestion data and compared to observer grading of wall motion. Inter and intra-observer variability in the highest correlating metric was assessed using Bland–Altman analysis calculated from two separate observations on a subset of data. Key Results All the metrics tested showed significant correlation with the observer rating scores. Line analysis (LA) produced the highest correlation coefficient of 0.74 (95% CI: 0.55–0.86), p < 0.001 (Spearman Rho). Bland–Altman analysis of the inter- and intra-observer variability for the LA metric, showed almost zero bias and small limits of agreement between observations (−0.039 to 0.052 intra-observer and −0.051 to 0.054 inter-observer, range of measurement 0–0.353). Conclusions & Inferences The LA index of colonic motility derived from cine MRI registered data provides a quick, accurate and non-invasive method to detect wall motion within the ascending colon following a colonic stimulus in the form of a macrogol drink

Technical report: Inter- and intra-rater reliability of regional gastrointestinal transit times measured using the 3D-Transit electromagnet tracking system

Researchers were indirectly funded from their research and training positions

Hepatic manifestations of Wilson's disease: 12-year experience in a Swiss tertiary referral centre.

Wilson&amp;rsquo;s disease is an inherited disorder of hepatic copper metabolism, leading to the accumulation of copper in the liver as well as the brain, cornea and other organs. Here, we describe the adult cases of hepatic Wilson&amp;rsquo;s disease diagnosed at the Division of Gastroenterology and Hepatology of the University Hospital Lausanne, Switzerland between September 2004 and August 2016. Clinical manifestations, results of diagnostic tests, management and outcomes of adult patients with hepatic Wilson&amp;rsquo;s disease were assessed based on standardised medical records. In addition, liver histology was reviewed and the lesional patterns were recorded. Ten new adult cases of hepatic Wilson&amp;rsquo;s disease were diagnosed in our centre between September 2004 and August 2016. Male to female ratio was 1:1 and median age at diagnosis was 26 (range 18&amp;ndash;56) years. Four patients presented with acute liver failure, four with persistently elevated liver function tests, and two with decompensated cirrhosis; none had neurological manifestations. Only one patient had a Kayser-Fleischer corneal ring. Median ceruloplasmin level at diagnosis was 0.13 (range &amp;lt;0.03&amp;ndash;0.30) g/l, median 24-hour urinary copper excretion was 2.8 (range 0.3&amp;ndash;77.3) &amp;mu;mol, and median hepatic copper concentration was 789 (range 284&amp;ndash;1677) &amp;mu;g/g. At least one mutation in the ATP7B gene was identified in eight patients. Allelic frequency of the common H1069Q mutation was 19%. Leipzig score was &amp;ge;5 in all patients. Three patients presenting with acute liver failure and the two with decompensated cirrhosis underwent successful liver transplantation. One patient with acute liver failure recovered under chelation therapy, as predicted by a Dhawan score &amp;lt;11. D-penicillamine was used as first-line chelator treatment, with a subsequent switch to trientine due to adverse effects in three out of six patients. The clinical presentation of hepatic Wilson&amp;rsquo;s disease is highly variable. Three out of 10 patients were diagnosed at an age &amp;gt;35 years. A high index of suspicion in clinically compatible situations is key

Wireless pH-motility capsule for colonic transit: prospective comparison with radiopaque markers in chronic constipation

Colon transit (CT) measurements are used in the management of significant constipation. The radiopaque marker (ROM) method provides limited information.We proposed to validate wireless motility capsule (WMC), that measures pH, pressure and temperature, to ROM measurement of CT in patients with symptomatic constipation evaluated at multiple centers. Of 208 patients recruited, 158 eligible patients underwent simultaneous measurement of colonic transit time (CTT) using ROM (Metcalf method, cut off for delay >67 h), and WMC (cutoff for delay >59 h). The study was designed to demonstrate substantial equivalence, defined as diagnostic agreement >65% for patients who had normal or delayed ROM transit.Fifty-nine of 157 patients had delayed ROM CT. Transit results by the two methods differed: ROM median 55.0 h [IQR 31.0–85.0] and WMC (43.5 h [21.7–70.3], P  < 0.001. The positive percent agreement between WMC and ROM for delayed transit was ∼80%; positive agreement in 47 by WMC/59 by ROM or 0.796 (95% CI = 0.67–0.98); agreement vs null hypothesis (65%) P  = 0.01. The negative percent agreement (normal transit) was ∼91%: 89 by WMC/98 by ROM or 0.908 (95% CI = 0.83–0.96); agreement vs null hypothesis (65%), P  = 0.00001. Overall device agreement was 87%. There were significant correlations ( P  < 0.001) between ROM and WMC transit (CTT [ r  = 0.707] and between ROM and combined small and large bowel transit [ r  = 0.704]). There were no significant adverse events.The 87% overall agreement (positive and negative) validates WMC relative to ROM in differentiating slow vs normal CT in a multicenter clinical study of constipation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79053/1/j.1365-2982.2010.01517.x.pd

Gastric transit and small intestinal transit time and motility assessed by a magnet tracking system

<p>Abstract</p> <p>Background</p> <p>Tracking an ingested magnet by the Magnet Tracking System MTS-1 (Motilis, Lausanne, Switzerland) is an easy and minimally-invasive method to assess gastrointestinal transit. The aim was to test the validity of MTS-1 for assessment of gastric transit time and small intestinal transit time, and to illustrate transit patterns detected by the system.</p> <p>Methods</p> <p>A small magnet was ingested and tracked by an external matrix of 16 magnetic field sensors (4 × 4) giving a position defined by 5 coordinates (position: <b>x, y, z, and angle: θ, ϕ)</b>. Eight healthy subjects were each investigated three times: (1) with a small magnet mounted on a capsule endoscope (PillCam); (2) with the magnet alone and the small intestine in the fasting state; and (3) with the magnet alone and the small intestine in the postprandial state.</p> <p>Results</p> <p>Experiment (1) showed good agreement and no systematic differences between MTS-1 and capsule endoscopy when assessing gastric transit (median difference 1 min; range: 0-6 min) and small intestinal transit time (median difference 0.5 min; range: 0-52 min). Comparing experiments (1) and (2) there were no systematic differences in gastric transit or small intestinal transit when using the magnet-PillCam unit and the much smaller magnetic pill. In experiments (2) and (3), short bursts of very fast movements lasting less than 5% of the time accounted for more than half the distance covered during the first two hours in the small intestine, irrespective of whether the small intestine was in the fasting or postprandial state. The mean contraction frequency in the small intestine was significantly lower in the fasting state than in the postprandial state (9.90 min^-1vs. 10.53 min^-1) (p = 0.03).</p> <p>Conclusion</p> <p>MTS-1 is reliable for determination of gastric transit and small intestinal transit time. It is possible to distinguish between the mean contraction frequency of small intestine in the fasting state and in the postprandial state.</p

Colonic movements in healthy subjects as monitored by a Magnet Tracking System

Rapport de synthèse : Le Magnet Tracking System (MTS) est une technique peu invasive d'investigation de la motilité de l'entier du tube digestif. Elle repose sur le suivi de la progression d'un aimant par des senseurs externes en temps réel et dans les 3 dimensions. Dans cette étude, le MTS a été utilisé pour étudier les caractéristiques de propulsion propres aux différents segments coliques ainsi que pour comparer le transit de l'aimant permanent du MTS à celui de marqueurs radioopaques habituellement utilisés. Dix hommes et 10 femmes ayant un transit gastro-intestinal régulier ont ingéré simultanément un aimant de MTS et une capsule contenant 10 marqueurs radio-opaques, à 20h00. Les enregistrements se sont ensuite déroulés sur 2 matinées successives de 5 heures. L'analyse des données brutes recueillies a permis de réaliser une projection spatio-temporelle de la trajectoire de l'aimant dans le tube digestif ainsi qu'une description précise de l'origine, de la direction, de l'amplitude et de la vitesse des mouvements coliques. Des radiographies d'abdomen ont permis de comparer les positions respectives des marqueurs radio-opaques et de l'aimant du MTS. Durant 90% du temps d'enregistrement, l'aimant était immobile ou présentait des mouvements alternatifs de faible amplitude. Le reste des enregistrements consiste en activité propulsive dont 20% représentent des déplacements rétrogrades et une description très précise de 34 mouvements de masses. L'analyse des déplacements démontre une distribution bimodales des vitesses voisine de 1.5 et 50 cm /min, ce tant en direction orale que caudale. Deux tiers des distances parcourues le sont à vitesse rapide. L'analyse segmentaire confirme une progression horaire absolue supérieure dans le côlon gauche que droit. L'analyse détaillée par segment colique, reposant sur la description des déplacements enregistrés correspond aux rôles reconnus des différents segments, notamment de aire de stockage et de conditionnement du côlon ascendant ou de transit du côlon descendant. La comparaison des 2 sexes démontre un nombre plus important de mouvements, particulièrement de mouvements de masse chez l'homme. Les radiographies montrent une bonne corrélation entre la position de l'aimant et celle des marqueurs radio-opaques. Le MTS permet ainsi une description précise des caractéristiques propulsives des différents segments coliques, notamment par l'analyse détaillée des progressions à vitesses lente et rapide et leurs directions. Des distinctions peuvent également être notées en fonction du sexe. Ces investigations offrent de nouvelles perspectives pour l'étude des troubles de la motilité digestive

L'astigmatisme dans la chirurgie de la cataracte. Etude retrospective de 1304 cas. [Astigmatism in cataract surgery. Retrospective study of 1,304 cases]

We performed a retrospective computerized study of 1304 consecutive cataract extractions, of which 251 were intracapsular and 1053 extracapsular. The analysis of surgically induced astigmatism after a mean follow-up of 22.8 months involved 639 cases. Operations were performed by two experienced surgeons using a similar and standardized technique; however the location of the incision varied without selecting patients: 391 were corneal, 248 limbal. We found that corneal incision gives significantly more against-the-rule astigmatism (average -0.61 dptr) than limbal incision (average -0.32 dptr). The suture induced astigmatism has no determining effect on the final astigmatism (correlation coefficient = 0.011). Selective suture cutting is an interesting technique for an individual dosage of the amount of final astigmatism

Complications de la chirurgie de la cataracte. Etude retrospective de 1304 cas. [Complications of cataract surgery. Retrospective study of 1,304 cases]

This retrospective study concerns complications arising from 1304 first operations for cataract carried out between 1982 and 1987 by two surgeons having followed the same training and using the same techniques. Loss of vitreous (2.5%) cystoid macular edema (1.9%), and retinal detachement (1.1%) are those complications occurring most frequently in this series. Other serious complications, in descending order, are trauma (0.7%), iris prolaps (0.5%), corneal dystrophy (0.4%), pupillary block (0.3%), expulsive hemorrhage (0.15%), loss of the nucleus in the vitreous (0.07%), panophthalmia (0.07%). Secondary cataract was noted in 31% of cases