Cooling of a vial in a snapfreezing device without using sacrificial cryogens

A fresh and frozen high-quality patient bio-sample is required in molecular medicine for the identification of disease-associated mechanism at molecular levels. A common cooling procedure is immersing the tissue enclosed in a vial in a coolant such as liquid nitrogen. This procedure is not user friendly and is laborious as reducing the lag time from excision time to freezing depends on the logistic organizational structure within a hospital. Moreover snapfreezing must be done as soon as possible after tissue excision to preserve the tissue quality for molecular tests. Herein, we report an electrically powered snap freezing device as an alternative to quenching the vial in liquid nitrogen and therefore can be used directly at the location where the tissue is acquired. This device also facilitates the study of the effect of freezing conditions on the various molecular processes in the samples. Cooling experiments of a vial in the snap freezing device show that the cooling rates similar to or faster than quenching in liquid nitrogen are feasible. We performed experiments with several set point conditions and compared the results with a mathematical model

Radiological Position and Clinical Outcome of Preoperative Self-Expanding Metal Stents for Obstructing Colonic Cancer: A Single-Centre Cohort Study.

BACKGROUND:Preoperative placement of self-expanding metal stents is used in patients with obstructing colon carcinoma to prevent an emergency operation. The perceived benefits remain the subject of discussion. The data-evaluating function and complications of stents in relation to radiological position are limited. METHODS:Patients receiving a preoperative stent between 2003 and 2013 were retrospectively analysed in this single-centre study. We analysed radiological deployment, eccentricity and angulation of the stent directly after placement. Endpoints were clinical success (resolution of ileus), complications needing non-elective surgery (blow-out, perforation, persistent ileus, dislocation) and other complications (bleeding, infiltrate). Associations were corrected for other potential influences. RESULTS: Eighty-two patients were included. In 22 patients (26.8%), the stent was placed proximal to the splenic flexure. Clinical success was present in 85.4%. Twenty-two patients (26.8%) had a complication of which 16 (19.5%) underwent urgent surgery for insufficient functioning of the stent; there were two blow-outs (2.4%). A more symmetrically placed stent was associated with clinical success (p = 0.042), with large overlap between groups. However, no association was found with non-elective surgery or complications. Also, angulation and deployment were unassociated with these outcomes. CONCLUSIONS: We could not establish an association between symmetry, angulation or deployment of self-expandable colonic stents with clinical success and complications

Darmkankerchirurgie sinds het bevolkingsonderzoek: Veranderingen in volume en wachttijden onderzocht

Objective To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Design Descriptive study. Method Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 20112015 were included. The volume and median waiting times for the years 20112015 are described. Waiting times from first tumor positive biopsy until the operation (biopsyoperation) and first preoperative visit to the surgeon until the operation (visitoperation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visitoperation for academic and nonacademic hospitals and for screening compared to nonscreening patients. Results In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsyoperation significantly decreased (ß: 0.94, 95%BI) over the years 20142015 compared to 20112013. In nonacademic hospitals, the waiting time visitoperation also decreased significantly (ß: 0.89, 95%BI 0.870.90) over the years 20142015 compared to 20112013. No difference was found in waiting times between patients referred to the surgeon through screening compared to nonscreening. Conclusion There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery

Surgery for colorectal cancer since the introduction of the Netherlands national screening programme Investigations into changes in number of resections & waiting times for surgery

Objective To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Design Descriptive study. Method Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 20112015 were included. The volume and median waiting times for the years 20112015 are described. Waiting times from first tumor positive biopsy until the operation (biopsyoperation) and first preoperative visit to the surgeon until the operation (visitoperation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visitoperation for academic and nonacademic hospitals and for screening compared to nonscreening patients. Results In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsyoperation significantly decreased (ß: 0.94, 95%BI) over the years 20142015 compared to 20112013. In nonacademic hospitals, the waiting time visitoperation also decreased significantly (ß: 0.89, 95%BI 0.870.90) over the years 20142015 compared to 20112013. No difference was found in waiting times between patients referred to the surgeon through screening compared to nonscreening. Conclusion There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery.</p

Hyoscine N-butylbromide does not improve polyp detection during colonoscopy:A double-blind, randomized, placebo-controlled, clinical trial

Background: Colonoscopy is used for the detection of neoplastic polyps, although a significant miss rate has been reported. Limited data suggest that the administration of the antispasmodic hyoscine N-butylbromide during colonoscopy improves polyp detection. Objective: To investigate whether the use of 20 mg hyoscine N-butylbromide intravenously during colonoscopy improves polyp detection or removal. Design: A prospective, double-blind, placebo-controlled, randomized, clinical trial. Setting: Nonacademic teaching hospital. Patients: This study involved 674 patients who were routinely referred and accepted for either diagnostic or screening colonoscopy. Intervention: Intravenous injection of either 1 mL hyoscine N-butylbromide (n = 340) or 0.9% NaCl solution (n = 334) when withdrawal was started. Main Outcome Measurements: Polyp detection rate (PDR), adenoma detection rate (ADR), and the advanced lesion detection rate (ALDR), 5% trimmed mean number of polyps, mean withdrawal time. Results: The cecal intubation rate was 96%. The PDR, ADR, and ALDR were 56% versus 60%, 30% versus 31%, and 14% versus 14% in the hyoscine N-butylbromide and placebo groups, respectively (all P values > .25). The means of the total number of detected, removed, and harvested polyps per patient were 1.13 versus 1.21, 1.03 versus 1.06, and 0.89 versus 0.89 in the hyoscine N-butylbromide and placebo groups, respectively (all P values > .37). Mean withdrawal time was 561 versus 584 seconds in the hyoscine N-butylbromide and placebo groups, respectively (P = .34). Multivariate analysis demonstrated no effect of hyoscine N-butylbromide on the investigated parameters. Limitations: Only experienced colonoscopists participated in the study. Conclusion: We found no evidence to support the use of hyoscine N-butylbromide during withdrawal of the colonoscope to improve polyp detection or removal. (Clinical trial registration number: ISRCTN25405865.) (Gastrointest Endosc 2012;75:835-40.

Continuous monitoring of colonoscopy performance in the Netherlands: First results of a nationwide registry

Background To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for colonoscopy. This study aimed to assess the feasibility of linking two national registries (one for colonoscopy and one for adverse events of gastrointestinal endoscopies in the Netherlands), and to describe the results of colonoscopy quality per indication. Methods This retrospective study was conducted with prospectively collected data of the Dutch Gastrointestinal Endoscopy Audit (DGEA) and the Dutch Registration of Complications in Endoscopy (DRCE). Data between 01-01-2016 and 01-01-2019 were analyzed. To calculate adverse event rates, data were linked at the level of endoscopy service. Results During the 3-year study period, 266 981 colonoscopies were recorded in DGEA. Of all indications, cecal intubation rate was highest in fecal immunochemical test (FIT)-positive screening colonoscopies (97.1%), followed by surveillance (93.2%), diagnostic (90.7%), and therapeutic colonoscopies (83.1%). The highest rate of adequate bowel preparation was observed in FIT-positive screening colonoscopies (97.1%). A total of 1540 colonoscopy-related adverse events occurred (0.58% of all colonoscopies). Bleeding and perforation and rates were highest for therapeutic (1.56% and 0.51%, respectively) and FIT-positive screening (0.72% and 0.06%, respectively) colonoscopies. The colonoscopy-related mortality was 0.006%. Conclusion This study describes the first results of the Dutch national colonoscopy registry, which was successfully linked to data from the national registry for adverse events of gastrointestinal endoscopies. In this large dataset, performance varied between indications. Our results emphasize the importance of defining benchmarks per indication in future guidelines