Endoscopist-Directed Propofol.

Endoscopist-directed propofol (EDP) refers to delivery of propofol for endoscopic sedation under the direction of an endoscopist without any involvement of an anesthesia specialist (anesthesiologist or nurse anesthetist). EDP has been proven to be safe and is also cost-effective compared with the anesthetist delivered sedation for endoscopy. EDP has been endorsed by US gastroenterology societies as an appropriate paradigm for clinical practice.

The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature.

Introduction: The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy.

Case Presentation: A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis.

GABA and glutamate levels in occlusal splint-wearing males with possible bruxism.

Objective: The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions.

Design: MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic-pituitary-adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC).

The big picture: does colonoscopy work?

Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent.

MR imaging evaluation of pericardial constriction.

Abnormal thickening or rigidity of the pericardium may compromise normal cardiac function. This condition is known as pericardial constriction, or constrictive pericarditis. Several imaging modalities are used to evaluate the pericardium, including MR, computed tomography, and echocardiography, which can all play a complementary role aiding diagnosis.

Crossmatch-positive liver transplantation in patients receiving thymoglobulin-rituximab induction.

Background: Positive crossmatch (CM) in liver transplantation (LT) is associated with worse outcomes. Role of induction immunosuppression in this setting remains to be studied.

Methods: One thousand consecutive LT patients receiving rabbit antithymocyte globulin±rituximab induction were studied.

Optimal withdrawal and examination in colonoscopy.

The primary goal of most colonoscopies, whether performed for screening, surveillance, or diagnostic examinations (those performed for symptoms or positive screening tests other than colonoscopy) is the detection of neoplasia and its subsequent removal by either endoscopic polypectomy or referral for surgical resection. Unfortunately, colonoscopy has proved to be a highly operator-dependent procedure with regard to detection. Variable detection results in some of the cancers that occur in the interval before the next colonoscopy.

Intestinal transplantation in infants with intestinal failure.

Intestinal failure (IF) occurs when a person's functional intestinal mass is insufficient. Patients with IF are placed on parenteral nutrition (PN) while efforts are made to restore intestinal function through surgical or medical intervention. Patients who fail standard IF therapies may be candidates for intestinal transplantation (IT).

Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol.

Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20 mL alcohol versus 10 mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain.

Inflammation in response to glucose ingestion is independent of excess abdominal adiposity in normal-weight women with polycystic ovary syndrome.

Context: Inflammation and excess abdominal adiposity (AA) are often present in normal-weight women with polycystic ovary syndrome (PCOS).

Objective: We determined the effects of hyperglycemia on nuclear factor-κB (NFκB) activation in mononuclear cells (MNC) of normal-weight women with PCOS with and without excess AA.

Design: This was a prospective controlled study.

The metabolic syndrome, oxidative stress, environment, and cardiovascular disease: the great exploration.

The metabolic syndrome affects 30% of the US population with increasing prevalence. In this paper, we explore the relationship between the metabolic syndrome and the incidence and severity of cardiovascular disease in general and coronary artery disease (CAD) in particular. Furthermore, we look at the impact of metabolic syndrome on outcomes of coronary revascularization therapies including CABG, PTCA, and coronary collateral development.

Endoscopic ultrasound-guided pancreatic cyst ablation.

Pancreatic cystic neoplasms represent a wide spectrum of invariably benign to precancerous and malignant tumors. Endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and/or paclitaxel offers a nonoperative treatment for patients refusing or not eligible for surgery. Histopathology after resection in these patients has shown variable degrees of cyst epithelial ablation ranging from 0% to 100%.

MR imaging techniques for pancreas.

Pancreatic magnetic resonance (MR) imaging has become a useful tool in evaluating pancreatic disorders. Technical innovations in MR imaging have evolved over the last decade, with most sequences being performed in one or a few breath-holds. Three-dimensional sequences with thin, contiguous slices allow for improved spatial resolution on the postgadolinium images and MR cholangiopancreatography (MRCP).

Association between volume of endoscopic retrograde cholangiopancreatography at an academic medical center and use of pancreatobiliary therapy.

Background & Aims: Many advances have been made in pancreatobiliary imaging and endoscopy techniques. However, little is known about trends in use of endoscopic retrograde cholangiopancreatography (ERCP).

Methods: We performed a retrospective cohort study that analyzed data from 33,596 ERCPs performed at Indiana University Medical Center from 1994 to 2009.

Effect of the Centers for Medicare & Medicaid Services policy about deep sedation on use of propofol.

On 11 December 2009, the Centers for Medicare & Medicaid Services issued a policy stating that deep sedation can only be administered by an anesthesiologist, a certified registered nurse anesthetist, or a trained medical doctor or a doctor of osteopathy not involved in the performance of a medical procedure. Propofol is a popular sedation agent that is usually administered by anesthesia specialists in a service termed monitored anesthesia care (MAC). Monitored anesthesia care adds substantial new fees to procedural sedation.

Endoscopic ultrasound-guided Trucut biopsy of gastrointestinal mesenchymal tumor.

Background: Data on the utility of endoscopic ultrasound-guided Trucut biopsy (EUS-TCB) for suspected gastrointestinal mesenchymal tumor (GIMT) are limited. This study aimed to determine the diagnostic yield and complications from EUS-TCB for GIMT.

Methods: Consecutive patients with suspected upper gastrointestinal or rectal GIMT from the muscularis propria with a maximal diameter of 20 mm or more were enrolled in a prospective, single-center cohort.

Efficacy and effectiveness of colonoscopy: how do we bridge the gap?

Colonoscopy is sometimes considered the preferred colorectal cancer screening modality, yet this modality may be subject to variation in operator performance more than any other screening test. Failures of colonoscopy to consistently detect precancerous lesions threaten the effectiveness of this technique for the prevention of colorectal cancer. Studies on high-level adenoma detectors under optimal conditions have begun to establish the true efficacy of colonoscopy and further widen the gap between efficacy and effectiveness.

The extremely slow and variable activity of dihydrofolate reductase in human liver and its implications for high folic acid intake.

Numerous clinical trials using folic acid for prevention of cardiovascular disease, stroke, cognitive decline, and neural tube defects have been completed or are underway. Yet, all functions of folate are performed by tetrahydrofolate and its one-carbon derivatives. Folic acid is a synthetic oxidized form not significantly found in fresh natural foods; to be used it must be converted to tetrahydrofolate by dihydrofolate reductase (DHFR).

Diffusion-weighted imaging characteristics of primary central nervous system germinoma with histopathologic correlation: a retrospective study.

Rationale And Objectives: The aim of this study was to quantify, using diffusion-weighted magnetic resonance imaging, the microscopic rate of water diffusion in pure germinoma and to determine whether or not the apparent diffusion coefficient (ADC) values correlated with the different histologic components.

Materials And Methods: A retrospective analysis of echoplanar diffusion-weighted magnetic resonance images was conducted on 10 patients with 11 germinoma lesions. All images were obtained using 1.

Time management: a realistic approach.

Realistic time management and organization plans can improve productivity and the quality of life. However, these skills can be difficult to develop and maintain. The key elements of time management are goals, organization, delegation, and relaxation.

Minimizing complications in pancreaticobiliary endoscopy.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, post-procedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death).

Application of generalizability theory in estimating the reliability of ankle-complex laxity measurement.

Context: Generalizability theory is an appropriate method for determining the reliability of measurements obtained across more than a single facet. In the clinical and research settings, ankle-complex laxity assessment may be performed using different examiners and multiple trials.

Objective: To determine the reliability of ankle-complex laxity measurements across different examiners and multiple trials using generalizability theory.

Gastroenterologist-directed propofol: an update.

Gastroenterologist directed propofol has been proven safe in more than 220,000 published cases. Administration of low doses of opioid and/or benzodiazepine ("balanced propofol sedation") is the safest format for gastroenterologist directed propofol. Specific training is needed to undertake gastroenterologist directed propofol administration.

Connexin-43 upregulation in micrometastases and tumor vasculature and its role in tumor cell attachment to pulmonary endothelium.

Background: The modulation of gap junctional communication between tumor cells and between tumor and vascular endothelial cells during tumorigenesis and metastasis is complex. The notion of a role for loss of gap junctional intercellular communication in tumorigenesis and metastasis has been controversial. While some of the stages of tumorigenesis and metastasis, such as uncontrolled cell division and cellular detachment, would necessitate the loss of intercellular junctions, other stages, such as intravasation, endothelial attachment, and vascularization, likely require increased cell-cell contact.