Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn's disease: a prospective study

BACKGROUND AND AIMS

Following ileocolonic resection for Crohn's disease (CD), early endoscopic recurrence predicts recurrence of symptoms. The aim of the study was to compare ileocolonoscopy and wireless capsule endoscopy (WCE) for the detection of postoperative recurrence in CD.

METHODS

WCE and ileocolonoscopy were performed within six months following surgery in 32 prospectively enrolled patients. Two independent observers interpreted the results of WCE. Recurrence in the neoterminal ileum was defined by a Rutgeerts score>or=1. When observers at WCE did not concur, WCE results were considered as either true negative or true positive and sensitivity and specificity were calculated according to both assumptions.

RESULTS

Recurrence occurred in 21 patients (68%) and was detected by ileocolonoscopy in 19 patients. Sensitivity was 90% and specificity 100%. Sensitivity of WCE was 62% and 76% and specificity was 100% and 90%, respectively, depending on assumptions. There was a correlation between the severity of the lesions measured by both methods (p<0.05). Lesions located outside the scope of conventional endoscopy were detected by WCE in two thirds of patients with excellent interobserver agreement (kappa>0.9) for all lesions with the exception of ulceration (kappa=0.7).

CONCLUSIONS

The sensitivity of WCE in detecting recurrence in the neoterminal ileum was inferior to that of ileocolonoscopy. In contrast, WCE detected lesions outside the scope of ileocolonoscopy in more than two thirds of patients. Additional follow up studies are needed to assess the clinical relevance of such lesions. At the present time, it seems that WCE cannot systematically replace ileocolonoscopy in the regular management of patients after surgery.

Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents

OBJECTIVES

Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period.

METHODS

Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification.

RESULTS

1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/10⁵ for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/10⁵ (+126%; P<0.001) and for UC, from 1.6 to 4.1/10⁵ (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC.

CONCLUSIONS

In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

Comparison between dipyridamole and adenosine as pharmacologic coronary vasodilators in detection of coronary artery disease with thallium 201 imaging

BACKGROUND

Both dipyridamole and adenosine are widely used as pharmacologic stressors with 201Tl imaging for detection of coronary artery disease. The purpose of this study was to compare dipyridamole and adenosine 201Tl imaging directly in patients with angiographically proved coronary artery disease.

METHODS AND RESULTS

Fifty-four patients were submitted to two planar 201Tl studies: one with dipyridamole and the other with adenosine. The interval between the two studies varied from 2 to 7 days and the order was assigned randomly. Three standard planar views were obtained 10 minutes and 4 hours after the injection of 3.0 mCi 201Tl. Administration of dipyridamole was as follows: 0.142 mg/kg/min during 4 minutes, followed by a slight exercise and 201Tl injection. The infusion of adenosine was as follows: 0.140 mg/kg/min during 6 minutes with injection of 201Tl after the third minute of infusion. Patients were asked to give their preference considering the number, type, severity, and duration of side effects on a scale from 0 (worst) to 5 (best). Reading was done by two experienced observers. The heart was divided into three segments per view. The change in systolic blood pressure was -12 +/- 11 mm Hg for adenosine and -5 +/- 10 mm Hg for dipyridamole (p < 0.001), and the change in heart rate was 18 +/- 10 beats/min for adenosine and 8 +/- 7 beats/min for dipyridamole (p < 0.001). With regions of interest, ischemic/normal wall ratios were determined: 0.78 +/- 0.06 for adenosine and 0.83 +/- 0.08 for dipyridamole (p < 0.001). Adenosine detected 295 normal, 170 ischemic, and 21 scar segments, whereas dipyridamole detected 326, 135, and 25 segments, respectively. Patients preferred adenosine (4.3 +/- 1.0 for adenosine vs 3.8 +/- 1.5 for dipyridamole; p < 0.04) mainly because of the short duration of side effects.

CONCLUSION

This study shows that the use of adenosine with 201Tl imaging may have some advantages over dipyridamole.

Egg dispersion in codling moth: Influence of egg extract and of its fatty acid constituents

Codling moth females (Cydia pomonella, Lepidoptera: Tortricidae) (CM) usually lay single eggs and have a tendency to disperse. In a first experiment we observed that single females exposed to 20 apples distribute their eggs regularly among apples, suggesting a dispersive oviposition behavior. In a dual-choice situation, isolated females avoided oviposition on areas of cardboard treated with a methylene dichloride egg extract at the dose of ca. 1.0 egg equivalent/cm(2). A strong avoidance was obtained in response to a 20-fold dose, which was accompanied by a significant reduction of total oviposition. Seven major compounds found by GC analyses in the methylene dichloride extract of 2 to 3-day-old eggs were saturated or unsaturated C14-C18 straight-chain fatty acids: myristic acid, palmitic acid, palmitoleic acid, stearic acid, oleic acid, linoleic acid, and linolenic acid. This was confirmed by GC-MS analysis of an extract made by ethyl ether. Smaller amounts of three methyl esters were also identified as methyl myristate, methyl palmitate, and methyl stearate. A blend of the seven fatty acids (FA) mimicked rather well the avoidance provoked by the extract, and this avoidance was confirmed by choice between treated and untreated fruits by single females. The treatment of apples with the 7FA mixture induced an aggregative distribution of the eggs among apples. We also found that the amounts of fatty acids harvested in the extract depend on the egg age. Amounts of fatty acids increased until eggs were 4 days old and then decreased before hatching. In this paper we discuss the possible role of simple molecules, such as fatty acids and their esters, as semiochemicals indicative of juvenile tissues.

Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study

BACKGROUND AND AIMS

Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome.

METHODS

Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected.

RESULTS

In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups.

CONCLUSIONS

Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.

Comparison between technetium-99m-teboroxime and thallium-201 dipyridamole planar myocardial perfusion imaging in detection of coronary artery disease

Technetium-99m (TC-99m)-teboroxime is a new myocardial perfusion imaging agent. The purpose of this prospective study was to compare Tc-99m-teboroxime with thallium-201 imaging after the administration of dipyridamole. Thirty patients referred for the evaluation of chest pain were studied with both thallium-201 and Tc-99m-teboroxime dipyridamole scans (mean interval 2 days). Dipyridamole was administered at 0.142 mg/kg/min for 4 minutes. Planar imaging (3 standard views) was obtained at 5 and 240 minutes after the injection of 2.2 mCi of thallium-201. Tc-99m-teboroxime (18 to 25 mCi) was injected after dipyridamole infusion. A second injection, at rest, was repeated 4 hours later. Planar imaging (3 standard views of 1 minute/view for the first 2 views, and 90 seconds for the last view) was obtained 2 minutes after Tc-99m-teboroxime injection. Blinded reading was performed by 3 observers. Thallium-201 showed perfusion defects in 182 myocardial segments corresponding to 33 of 45 (73%) significantly stenosed coronary arteries (greater than or equal to 70% reduction in endoluminal diameter), and Tc-99m-teboroxime detected 160 abnormal segments corresponding to 29 of 45 (64%) stenosed arteries. Thallium-201 and Tc-99m-teboroxime studies were normal in 3 patients. In conclusion, this study shows that there is a good correlation in the imaging results found with thallium-201 and Tc-99m-teboroxime using dipyridamole infusion on both a segmental and a diagnostic comparison.

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study

INTRODUCTION

Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD.

METHOD

All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD.

RESULTS

A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up.

CONCLUSION

During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

Effects of habitat on individual reproductive success of mature male parr of Atlantic salmon Salmo salar

The effect of the presence of stone blocks in the spawning habitat on the reproductive success of mature male parr of Atlantic salmon Salmo salar of various sizes and ages was tested in an artificial channel. Shelters allowed smaller individuals to contribute to egg fertilization as much as large parr, suggesting that the size-based dominance observed in a shelterless habitat was not maintained in a more complex habitat.

Study of effects of Bt maize (Zea mays) events on Lepidoptera Ostrinia nubilalis, Sesamia nonagrioidesin southwestern France

Crops of maize (Zea mays L.) were conducted in southwestern France with GMO (Genetic Modified Organism) vs isogenetic varieties in order to verify the control of European Corn Borer (ECB) Ostrinia nubilalis (Hübner) and the Corn Stalk Borer (CBS) Sesamia nonagrioides (Lefevbre) by GMO in field conditions. The bioassays were carried out in 1998 and 1999 before moratorium, then in 2005. Experiments involved respectively 18, 12 and 19 fields cultivated with Furio/Furio cb (GMO), Cecilia/ Elgina (GMO) and PR33P66/PR33P67 (GMO) varieties. These transgenic events expressed Cry1A(b) protein (Bt maize). Plants were noted for insect infestation assessment (number of larvae in stalks and ears per plant). Statistical tests used t-test on couple of plots. Results showed a significant difference in the density of both ECB and CBS between control and the two transgenic events. The two transgenic events acted differently. The control of the two Bt events on the two pests were differentiated and discussed. These experiments underlined the importance of field evaluation for testing real effects of transgenic events on crop according the environmental context.

A density-dependent model with reinvasion for estimating tsetse fly populations (Diptera: Glossinidae) through trapping

A simple density-dependent reinvasion model is described and used to estimate tsetse fly populations on the basis of removal trapping experiments. The model was tested on Glossina fuscipes fuscipes Newstead in the Central African Republic and G. palpalis palpalis (Robineau-Desvoidy) in the Republic of Congo (Brazzaville). The density-dependence is modelled by postulating that the inflow of flies each day is proportional to the deficit relative to the equilibrium population. Non-linear least square techniques were used to estimate the following parameters: the daily capture rate, the strength of the density-dependence, and the equilibrium fly population, at the beginning and at the end of the trapping experiment. The model ignores birth and death rates of flies and is applicable only when a rapid decrease in population occurs over a short period (between 10 and 20 days). Over longer periods one could not ignore the natural growth of the populations as well as other more complex density-dependent mechanisms.