Acute Intestinal Bleeding Research Articles

What is known about Peutz–Jeghers syndrome (a literature review)

Peutz–Jeghers syndrome (PJS) is an autosomal dominant disease, which in most cases is caused by mutation of the tumor suppressor gene STK11 and is characterized by the development of hamartomatous polyps in the digestive tract and the presence of hyperpigmented spots on the skin and mucous membranes. Late diagnosis of PJS leads to acute intestinal obstruction or bleeding. The aim of the study is to summarize the data and current views on the early diagnosis and treatment of PJS in children and processing information on monitoring of PJS complications. To achieve this goal, we have analyzed the sources of professional literature indexed in scientometric databases for the period 2014–2024. The analysis of the professional literature has shown that the triad is characteristic for PJS diagnosis: pigmented spots on the skin and oral mucosa, digestive tract polyposis, and heredity. The timing of symptom onset is an important aspect that requires further study of the clinical course and prognosis of the disease. Conclusions. Phenotypic suspicion involves the formation of risk groups using extraintestinal signs – pigmentation of the mucous membranes and lips – an early visual symptom that makes it possible to recognize PJS, prescribing timely examination and treatment long before the onset of complications. Dynamic observation and prevention of complications in risk groups – both in the presence of a family history and in newly diagnosed children with polyps and specific pigmentation should be provided. The main method of PJS diagnosis is endoscopic, and the main treatment is surgical.

Ultra-sensitive and label-free detection of Escherichia coli O157:H7 using graphene-based field effect transistor modified with heat-denatured casein

Sensitive detection of Escherichia coli O157:H7 (E. coli O157:H7) in suspected water samples is critical for containing the water-borne outbreak, which may cause acute diarrhea and intestinal bleeding. Here, we reported an improved graphene-based field effect transistor modified with heat-denatured casein (GFET) for sensitively detecting E. coli O157:H7 in real water samples. The heat-denatured casein coated on the graphene surface was served as a probe linker to bind with the specific antibody of E. coli O157:H7, and as a blocker to avoid the interference signal arising from the non-specific adsorption between the graphene surface and impurities in real water samples. The GFET biosensor provided a wide concentration range of 1–107 CFU·mL−1 for cultured E. coli O157:H7 with a detection limit of 1 CFU·mL−1. This developed GFET biosensor can also discriminate E. coli O157:H7 from other interfering substances with a high selectivity. In addition, correlation analysis of the E. coli O157:H7 in real samples using the GFET biosensor were proved the high agreement with enzyme-linked immunosorbent assay. The mass-produced GFET biosensor can achieve ultra-sensitive and label-free detection for the E. coli O157:H7 in water sample, promising prospective environmental monitoring application in the future.

Management of complicated colorectal cancer in Benghazi hospitals

Introduction: Colorectal cancer (CRC) is the third most frequent malignant disease in men and second most frequent in women. The treatment of emergency cases of CRC presented with complication is different than elective controlled cases. Aim: of this study is to find the best way to treat a patient admitted as an emergency case of complicated colorectal cancer. Methods: The medical data of 102 patients was retrospectively evaluated for those who were admitted as emergency cases with acute or subacute intestinal obstruction, perforation or bleeding colorectal cancer to Al-Jalla Hospital, Benghazi Libya. Three different emergency treatment methods were received as follow: · Tumor resection, · Damage control procedure with elective or semi elective resection, and · No radical treatment. Primary endpoints were 6 months mortality and morbidity. Secondary endpoints were length of hospital stay, number of lymph nodes, rate of radical R0 resections, and the number of patients who had received chemo-radiotherapy. Results: 55 patients had immediate resection and colostomy. 33 patients were inoperable because the cancer was too advanced or they were too ill to tolerate an operation. 10 had damage control followed by elective resection. There was no statistically proven significant difference between immediate resections and 2-stage treatment. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection. Conclusion: This study couldn't determine which treatment is better, even with using staging resection.

Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation

To analyze the achievements of laparoscopic surgery in the Central Federal District of Russia and outline perspective trends for further application. The study included adult patients with abdominal surgical diseases hospitalized in general surgical departments of the Central Federal District between 2014 and 2021. We analyzed the prevalence of elective and emergency laparoscopic surgeries. Incidence and results of laparoscopic interventions between 2018 and 2021 were estimated considering primary statistical data presented in the annual collections of the Chief Surgeon of the Ministry of Health of Russia «Surgical care in the Russian Federation». The absolute number of laparoscopic surgeries in the Central Federal District increased from 23.686 to 80.489 (by 3.4 times) between 2014 and 2021. The annual number of elective laparoscopic surgeries exceeded the number of emergency ones up to 2019. In 2020-2021, this situation changed in favor of emergency abdominal procedures. Laparoscopic surgeries are the most common for in acute cholecystitis (71.06-81.10% of all laparoscopic interventions annually) and acute appendicitis (46.85-55.60%). In 2020 and 2021, the absolute number of laparoscopic appendectomies exceeded the number of laparoscopic cholecystectomies. These values are lower for perforated ulcers (15.44-20.39%) and acute pancreatitis (32.40-36.71%). Laparoscopic operations are rare for acute intestinal obstruction, strangulated hernia and ulcerative gastroduodenal bleeding. In elective surgery, high availability of laparoscopic surgeries was noted in patients with cholelithiasis (89.40-93.78%), hiatal hernia (62.12-77.27%) and adrenal gland diseases (64.23-87.25%). The most intensive increment of availability (by 2.4 times) was noted for inguinal hernia from minimum level (10.98%) in 2018 to 26.00% in 2021. Mortality after some laparoscopic operations decreased in comparison with laparotomy by 12-45 times (2018-2021). However, this aspect and results of laparoscopic surgeries in case of delayed hospitalization require additional study. Analysis of laparoscopic surgery showed the timeliness of beginning and development of this direction In Russia. The prospect of further development of laparoscopic surgery for abdominal diseases is determined by modern trends. These are increase in the number of laparoscopic operations for acute appendicitis, acute cholecystitis and perforated ulcers, as well as higher number of early (after admission) operations.

Jejunum cavernous haemangioma - A rare cause of gastrointestinal bleeding.

We report a case of a 69-year-old male patient with gastrointestinal bleeding manifesting with melaena. Upper and lower endoscopy were negative for the bleeding aetiology. On small bowel capsule endoscopy, several violaceous lesions in the proximal jejunum were identified. The patient was submitted to segmental intestinal resection being diagnosed with a cavernous jejunum haemangioma, a rare cause of acute intestinal bleeding.

Un diverticolo (dav)vero sanguinante

Meckel diverticulum has been suspected and then diagnosed at laparoscopic exploration of the abdomen in a severely anaemic 16-month-old child with acute intestinal bleeding. The surgical indication of all unexplained intestinal bleedings is discussed.

1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain

Abstract Background Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare Case Summary we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma. Discussion Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin. Conclusions Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.

Acute Middle Gastrointestinal Bleeding Risk Associated with NSAIDs, Antithrombotic Drugs, and PPIs: A Multicenter Case-Control Study.

BackgroundMiddle gastrointestinal bleeding (MGIB) risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs), and whether PPI use affects the interactions between MGIB and antithrombotic drugs.MethodsIn this multicenter, hospital-based, case-control study, 400 patients underwent upper and lower endoscopy, 80 had acute overt MGIB and 320 had no bleeding and were matched for age and sex as controls (1:4). MGIB was additionally evaluated by capsule and/or double-balloon endoscopy, after excluding upper and lower GI bleeding. Adjusted odds ratios (AOR) for MGIB risk were calculated using conditional logistic regression. To estimate the propensity score, we employed a logistic regression model for PPI use.ResultsIn patients with MGIB, mean hemoglobin level was 9.4 g/dL, and 28 patients (35%) received blood transfusions. Factors significantly associated with MGIB were chronic kidney disease (p<0.001), liver cirrhosis (p = 0.034), NSAIDs (p<0.001), thienopyridines (p<0.001), anticoagulants (p = 0.002), and PPIs (p<0.001). After adjusting for these factors, NSAIDs (AOR, 2.5; p = 0.018), thienopyridines (AOR, 3.2; p = 0.015), anticoagulants (AOR, 4.3; p = 0.028), and PPIs (AOR; 2.0; p = 0.021) were independently associated with MGIB. After adjusting for propensity score, the use of PPIs remained an independent risk factors for MGIB (AOR, 1.94; p = 0.034). No significant interactions were observed between PPIs and NSAIDs (AOR, 0.7; p = 0.637), LDA (AOR, 0.3; p = 0.112), thienopyridine (AOR, 0.7, p = 0.671), or anticoagulants (AOR, 0.5; p = 0.545).ConclusionsOne-third of patients with acute small intestinal bleeding required blood transfusion. NSAIDs, thienopyridines, anticoagulants, and PPIs increased the risk of acute small intestinal bleeding. However, there were no significant interactions found between antithrombotic drugs and PPI use for bleeding risk.

АКТУАЛЬНІ ПРОБЛЕМИ НЕВІДКЛАДНОЇ ХІРУРГІЇ КОЛОРЕКТАЛЬНОГО РАКУ

Здійснено ретроспективний аналіз результатів лікування 136 хворих на ускладнений рак товстої кишки, оперованих у клініці в 2008–2014 рр. Вік пацієнтів перебував у межах 36–94 років (середній – (68,8±12,1 року). У більшості хворих РТК діагностовано в клініці у зв’язку з виникненням того чи іншого ускладнення – 117 (86 %). Домінуючим ускладненням колоректального раку виявилась гостра обтураційна непрохідність – ізольовано у 105 (77,2 %) хворих, у поєднанні з перфорацією пухлини, перитонітом – у 24 (17,6 %) пацієнтів, кишковою кровотечею – в 1 (0,8 %) хворого. Перфорацію пухлини, перитоніт констатовано у 3 (2,2 %) хворих, гостру кишкову кровотечу – в 3 (2,2 %) пацієнтів. У 81,1 % спостережень перитоніт мав дифузний характер. Радикальні операції виконано у 68 (50 %) хворих, паліативні – у 18 (13,2 %), симптоматичні – в 50 (36,8 %) пацієнтів. Відповідно до класифікацією TNM, І стадію пухлини встановлено у 0,7 % оперованих, ІІ стадію – у 31 % хворих, ІІІ і IV стадії, відповідно, – у 31,4 та 37,0 % пацієнтів. Післяопераційні ускладнення розвинулись у 10 хворих (7,3 %) і мали в основному гнійно-септичний характер. Появу третинного перитоніту було визнано у 17 (12,5 %) прооперованих. Релапаротомії виконано 21 хворому (15,4 %), здебільшого з причини перитоніту, ретракції колостом. Середній ліжкодень склав 16,2±7,7. Померли 23 хворі – післяопераційна летальність – 16,9 %. Третинний перитоніт призвів до летального кінця в 15 пацієнтів (88,2 %). Основною причиною смерті визнано поліорганну недостатність як прояв тяжкого сепсису. Основними аспектами проблеми ускладненого раку товстої кишки (УРТК), які потребують комплексного вирішення, є зростання захворюваності, запізніла госпіталізація пацієнтів, потенційований ризик венозних тромбозів та емболій, третинний перитоніт, підвищення фахової онкологічної підготовки хірургів.

Su1657 Sequential Change of Endoscopic Findings and Therapeutic Efficacy of Anti-TNFα Therapy for Patients With Intestinal BehçET's Disease

Behçet's disease (BD) is a systemic inflammatory disease with the histopathological features of leukocytoclastic vasculitis characterized by repeated oral and genital ulcerations, ocular lesions, skin manifestations, arthritis, vasculaitis, and gastrointestinal involvements. Intestinal Behçet's disease (BD) is characterized by intestinal inflammation with round and oval ulcers typically in the ileocecum and is associated with gastrointestinal symptoms, which are often uncontrollable, relapsing, and can cause acute intestinal bleeding or perforation.

Control of acute phase intestinal bleeding after percutaneous coronary intervention by discontinuing dual antiplatelet therapy and implementing intra-aortic balloon pumping

Aspirin's efficacy for the prevention of secondary vascular disease is well supported. However, more attention should be given to its side effects, especially gastrointestinal injury. A 62-year-old man suffered acute myocardial infarction of the left main trunk. Although a percutaneous coronary intervention, using a bare metal stent, was successful, intractable in-bowel bleeding developed. To control the bleeding, we discontinued dual antiplatelet therapy during the acute phase, and used intra-aortic balloon pumping to provide sufficient coronary flow to prevent stent thrombosis. This strategy controlled intestinal bleeding without any thrombotic complications, indicating that intra-aortic balloon pumping is effective for preventing stent thrombosis.<Learning objective: Aspirin often causes bleeding complications, especially in the gastrointestinal tract. We experienced a case with severe intestinal bleeding of unknown origin during the acute phase after percutaneous coronary intervention for acute myocardial infarction. The dual antiplatelet therapy was necessarily stopped, which could have resulted in stent thrombosis. We used intra-aortic balloon pumping to prevent the stent thrombosis through coronary flow augmentation.>

False-positive F-18 FDG uptake in PET/CT studies in pediatric patients with abdominal Burkitt's lymphoma

In pediatric patients with abdominal Burkitt's lymphoma, the involvement of the gastrointestinal tract and abdominal lymph nodes are the main presenting feature of the disease. Chemotherapy is the main treatment modality and could be preceded by surgical excision of the abdominal masses. To achieve cure or long-term disease-free survival a balance has to be struck between aggressive chemotherapy and the probability of tumor necrosis secondary to treatment complicated by acute infections, perforation or intestinal bleeding. F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) has been recommended over conventional imaging modalities for the follow-up of these patients and for monitoring treatment response. As the incidences of postchemotherapy complications are high, the positive predictive value of PET/CT studies in these patients is very low and the false-positive rate is high from acute infections and tumor necrosis. Accordingly, histopathological confirmation of positive lesions on F-18 FDG-PET/CT studies is essential. This is especially important as post-therapy complications might present with nonspecific and nonurgent symptoms. At the same time initiating a second course of salvage chemotherapy is risky. Retrospectively reviewed F-18 FDG-PET/CT studies for 28 pediatric patients with abdominal Burkitt's lymphoma and diffuse large B-cell lymphoma after their treatment with chemotherapy or surgery. Four positive studies were found. All had pathological verification and were because of acute inflammation and tumor necrosis and there was no evidence of viable tumor cells. One patient had multiple recurrent lesions in the abdomen after the initial surgical excision and before starting chemotherapy. The incidence of acute complications in this series is 10.7%. This study confirms the high incidence of tumor necrosis and inflammation after chemotherapy for the abdominal Burkitt's lymphoma and consequently, the incidence of true-positive F-18 FDG studies is low. This necessitates the need for histopathological confirmation of positive studies.

Multi-detector row CT of patients with acute intestinal bleeding: a new perspective using multiplanar and MIP reformations from submillimeter isotropic voxels

Acute intestinal bleeding is a severe condition, with a mortality rate of up to 40% in case of associated hemodynamic instability. The diagnosis of acute intestinal bleeding is often challenging and to date, there is no definite consensus upon the most appropriate technique for this specific diagnosis. This pictorial essay illustrates our preliminary use of multiplanar (MPR) and maximum intensity projection (MIP) reformations using MDCT scanner with submillimeter and isotropic voxels as an adjunct to axial images in patients with acute intestinal bleeding. MDCT examinations were routinely performed with 64-slice helical CT scanner and images were reconstructed 0.6-mm thickness at 0.5-mm intervals. Multiplanar reconstructions and MIP views were created with a commercially available workstation. Reformatted images from submillimeter isotropic voxels enhanced the depiction of subtle vascular abnormalities and served as a useful adjunct to the axial plane images to improve diagnostic capabilities. Although we are aware that reformatted images should not replace careful analysis of the axial images in patients with acute gastrointestinal bleeding, reformatted images from submillimeter isotropic voxels may clarify the cause of the bleeding, add confidence to image analysis and help interventional radiologists or surgeons improving planning approach.

Naproxen-PC: A GI safe and highly effective anti-inflammatory

We have been developing a family of phosphatidylcholine (PC)-associated NSAIDs, which appear to have improved GI safety and therapeutic efficacy in both rodent model systems and pilot clinical trials. As naproxen has been demonstrated to be associated with the lowest cardiovascular adverse events in comparison with both COX-2 selective inhibitors and conventional NSAIDs, we have been developing a Naproxen-PC formulation for evaluation in animal models and clinical trials. We have determined that an oil-based formulation of naproxen and triple strength soy lecithin provides excellent GI protection in both: 1) an acute NSAID-induced intestinal bleeding model in rats pretreated with L-NAME that are intragastrically administered a single dose of naproxen (at a dose of 50 mg/kg) vs the equivalent dose of Naproxen-PC; and 2) a more chronic model (at a naproxen dose of 25 mg/kg BID) in rats that have pre-existing hindpaw inflammation (induced with a intradermal injection of Complete Freund's Adjuvant/CFA). Both models demonstrate the superior GI safety of Naproxen-PC vs naproxen while this novel formulation had significant anti-inflammatory efficacy to reduce hindpaw edema and the generation of PGE(2) in the collected joint synovial fluid. Naproxen-PC appears to induce significantly less GI injury and bleeding in two rodent model systems while maintaining anti-inflammatory and COX-inhibitory activity.

The Effect of Thalidomide on Entero-Behcet's Disease

Behcet's disease is a chronic relapsing vasculitis characterized by recurrent aphthous oral and genital ulcers with uveitis. Multiple organs can be involved. Entero-Behcet's disease is often uncontrollable, relapsing, and can cause acute intestinal bleeding, fistula formation, or perforation. Corticosteroids, immunosuppressors, and colchicines are used to treat Entero-Behcet's disease with vary ing degree of success. Thalidomide may also be feasible. We present a 29-year-old male Entero-Behcet's patient suffering from abdominal pain, diarrhea, and back pain. He did not respond to prior treatments, but responded to thalidomide. (Korean J Pain 2009; 22: 104-106)

Gastro-Intestinal Bezoars: Thirty-Five Years Experience

Background and aims: Because of their rarity and late diagnosis, gastro-intestinal bezoars can be treated after the occurrence of some complications such as acute intestinal obstruction, strangulation, decubitus ulceration and bleeding. In this study, reasons for bezoar formation, measures to be taken and treatment modalities were investigated. Patients and methods: The files of the patients who were found to have gastro-intestinal bezoars and who were treated at Istanbul University, Cerrahpasa Medical Faculty General Surgery Department and Emergency Unit between the years 1970 and 2005 were analysed.Results: Thirteen (30%) of the 44 patients in the study were women, 31 (70%) were men: the mean age was 55.5 ± 19.6 (range 22–96) years. Enzymatic dissolution (3 patients) and endoscopic fragmentation (four patients) were unsuccessful. Laparoscopic gastrotomy (n = 2), gastrotomy(n = 16), gastric resection (n = 3), enterotomy (n = 12), segmental intestinal resection (n = 3), gastroduodenotomy (n = 1), and gastrotomy + enterotomy (n = 3) were performed. In two patients, bezoars were fragmented and milked to caecum. There were no major postoperative complications, except abdominal wound infection in 4 patients and one patient who had a recurrent intestinal bezoar five years after the operation. One of the patients died because of heart failure on the 7th postoperative day. Mean hospital stay was 9.5 ± 3.6 days. Conclusion: Even though rarely seen in digestive tract diseases, the probability of BZ formation should always be remembered. After the removal of BZs by conservative methods or surgery, precautions should be taken against recurrence and possible underlying psychiatric disorders should be treated.

Examining High Rates of Inadequate Bowel Preparation and Potential Causative Factors

Purpose: Inadequate bowel preparation (prep) is frequently observed during screening colonoscopy. Ramifications of poor prep include prolonged and incomplete procedures, increased costs, and the potential for missed lesions. We attempted to quantify the extent of inadequate prep at our institution and identify underlying causative factors. Methods: All colonoscopies performed at the Memphis Veterans Affairs Medical Center from January 1, 2006 through April 30, 2008 were retrospectively evaluated. Only screening colonoscopies that used sodium phosphate (NaP) or polyethylene glycol (PEG) were included in the review. Exclusion criteria included prior colonoscopy, inpatient status, nursing home residence, incomplete endoscopy report, and any colonoscopy performed for indications other than routine colorectal cancer screening (acute intestinal bleeding, iron deficiency, abdominal pain, constipation, diarrhea, and abnormal imaging findings). Prep adequacy was subjectively defined by the endoscopist at the time of the procedure as excellent, good, fair adequate, fair exam compromised, or poor. All patient data were obtained from the CORI and Computerized Patient Record System (CPRS) databases. Chi-squared tests were performed to determine statistical significance. Results: A total of 619 patients met all selection criteria and were included in the study. NaP prep was used in 83% and PEG in 17%. A strong correlation was seen between improved prep quality and the use of PEG (P= 0.06). No difference was seen between NaP and PEG in the number of adenomas detected. Overall prep adequacy was 11% excellent, 50% good, 29% fair adequate, 5% fair exam compromised, and 5% poor. Individual comorbidities such as diabetes mellitus, congestive heart failure, coronary artery disease, renal insufficiency, stroke and dementia were not significantly related to prep adequacy, but a strong correlation was seen between poorer prep quality and diabetes (P= 0.06). Improved prep quality was seen in procedures performed before 10 am (68% excellent/good) as compared to those performed after 10 am (52%) (P < 0.05). Patient attendance at a pre-colonoscopy educational class did not improve prep quality. Conclusion: At our institution 39% of patients undergoing screening colonoscopy had a prep adequacy that was less than good. Only colonoscopies performed after 10 am were significantly associated with poorer preps. These findings, coupled with our patient population's overall poor compliance with recommended follow up, indicate that a significant number of patients are not getting adequate colorectal cancer screening. Therefore, continued attempts to identify methods that improve bowel preparation, such as scheduling procedures earlier, should be made.

Assessing Variability in Surveillance Recommendations for Fair Adequate Bowel Preparations

Purpose: The Clinical Outcomes Research Initiative (CORI) system defines a fair adequate bowel preparation (prep) as one having “enough feces or liquid to prevent a completely reliable exam”. Prior studies have defined an acceptable prep quality as one that is considered excellent, good, or fair adequate. In addition, firm guidelines do not exist regarding appropriate surveillance intervals after fair adequate preps. The aim of this study is to determine if fair adequate preps are truly acceptable and if there is a consensus among endoscopists regarding recommended surveillance intervals for these preps. Methods: All colonoscopies performed at the Memphis Veterans Affairs Medical Center from January 1, 2006 through April 30, 2008 were retrospectively evaluated. Only outpatient screening colonoscopies were included in the review. Exclusion criteria included prior colonoscopy, inpatient status, nursing home residence, incomplete endoscopy report, and any colonoscopy performed for indications other than routine colorectal cancer screening (acute intestinal bleeding, iron deficiency, abdominal pain, constipation, diarrhea, and abnormal imaging findings). Bowel preparation adequacy was subjectively defined by the endoscopist at the time of the procedure as excellent, good, fair adequate, fair exam compromised, or poor. All patient data were obtained from the CORI and the Computerized Patient Record System (CPRS) databases. Chi-squared tests were performed to determine statistical significance. Results: A total of 623 patients met all selection criteria and were included in the study. Of these, 29% had a fair adequate prep. No significant difference was seen in the percentage of patients having fair adequate preps with adenoma (30%) as compared to patients with good (25%) and excellent (30%) preps. Interestingly, no clear consensus was seen in terms of recommended follow for fair adequate preps with or without adenomas (see Table).Table: Recommended Follow Up Intervals for Fair Adequate Bowel Preparations.Conclusion: A significant number of patients undergoing colonoscopy have fair adequate preps. These preps can potentially be considered acceptable since there is no difference in the percentage of patients having fair adequate preps that detect adenomas as compared to patients with good and excellent preps. However, a consensus does not exist regarding recommended surveillance intervals for fair preps. This lack of consensus may be due to the fact that a fair adequate prep is defined as not being “a completely reliable exam”. Therefore, formal guidelines need to be developed for surveillance intervals in patients with fair adequate bowel preparations.

The abdominal manifestations of the antiphospholipid syndrome

To study the abdominal manifestations of the antiphospholipid syndrome (APS). We reviewed the medical literature from 1968 to 2006 using MEDLINE and the key words: APS, anticardiolipin antibodies, lupus anticoagulant, antiphospholipid (aPL) antibodies, catastrophic antiphospholipid syndrome, liver, hepatic biliary, pancreas, spleen, gastrointestinal and abdominal. Liver involvement is the most frequent abdominal manifestation associated with APS. Various hepatic manifestations have been reported including Budd-Chiari syndrome, hepatic-veno-occlusive disease and occlusion of small hepatic veins, nodular regenerative hyperplasia, hepatic infarction, cirrhosis, portal hypertension, autoimmune hepatitis and biliary cirrhosis. Acute intestinal infarction, intestinal angina, and intestinal bleeding have also been reported in association with aPL in addition to few sporadic cases of splenic infarction and acute pancreatitis. A high index of suspicion for any signs of abdominal involvement should be considered in patients with APS. In addition screening for aPL should be carried out in patients who present with hepatic vein occlusion and unexplained signs of intestinal angina.

Endovascular Treatment of Renal Artery Bifurcation Stenoses with Branched Balloon Angioplasty

An 85-year-old man with left sided single kidney presented with end-stage renal failure after an acute intestinal bleeding. A complex bifurcational stenoses distally to a 6 months previously implanted ostial stent in the left renal artery was found on duplex imaging and angiogram. These two de-novo stenoses in the distal main renal artery and the proximal segment of the lower branch were simultaneously treated with a ultra-low profile, monorail bifurcation balloon catheter system (Avion Bifurcation RX2™, Invatec, Italy) that consists of a main vessel balloon (20/3.5 mm) and a side vessel balloon (20/2.75 mm). One day and three months postinterventionally, duplex ultrasound demonstrated no recurrent stenoses. Bifurcation balloon catheter systems for complex renal artery stenosis are discussed.