PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-5 (5)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
Document Types
1.  Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Patients with Inflammatory Bowel Disease 
Objective
For diagnosis, assessing disease activity, complications and extraintestinal manifestations, and monitoring response to therapy, patients with inflammatory bowel disease undergo many radiological studies employing ionizing radiation. However, the extent of radiation exposure in these patients is unknown.
Methods
A population-based inception cohort of 215 patients with inflammatory bowel disease from Olmsted County, Minnesota, diagnosed between 1990 and 2001, was identified. The total effective dose of diagnostic ionizing radiation was estimated for each patient. Linear regression was used to assess the median total effective dose since symptom onset.
Results
The number of patients with Crohn's disease and ulcerative colitis was 103 and 112, with a mean age at diagnosis of 38.6 and 39.4 yr, respectively. Mean follow-up was 8.9 yr for Crohn's disease and 9.0 yr for ulcerative colitis. Median total effective dose for Crohn's disease was 26.6 millisieverts (mSv) (range, 0–279) versus 10.5 mSv (range, 0–251) for ulcerative colitis (P < 0.001). Computed tomography accounted for 51% and 40% of total effective dose, respectively. Patients with Crohn's disease had 2.46 times higher total effective dose than ulcerative colitis patients (P = 0.001), adjusting for duration of disease.
Conclusions
Annualizing our data, the radiation exposure in the inflammatory bowel disease population was equivalent to the average annual background radiation dose from naturally occurring sources in the U.S. (3.0 mSv). However, a subset of patients had substantially higher doses. The development of imaging management guidelines to minimize radiation dose, dose-reduction techniques in computed tomography, and faster, more robust magnetic resonance techniques are warranted.
doi:10.1111/j.1572-0241.2008.01920.x
PMCID: PMC2831296  PMID: 18564113
2.  Endoscopic Ultrasound-Guided Gastric Botulinum Toxin Injections in Obese Subjects: A Pilot Study 
Obesity surgery  2008;18(4):401-407.
Background
Gastric injections of botulinum toxin A (BTA) may induce changes in gastric emptying and body weight, but results vary. BTA dose and depth of injection may affect efficacy. This study assessed changes in gastric emptying, satiation, symptoms, and body weight after endoscopic ultrasound (EUS)-guided injection of 100 or 300 U BTA into gastric antral muscularis propria of obese subjects.
Methods
Open label study of ten healthy, obese adults (age=29–49 years, body mass index=31–54 kg/m2) who received 100 U (n=4) or 300 U (n=6) BTA and were followed for 16 weeks. Measures included gastric emptying of solids (by scintigraphy), satiation (by maximum tolerated volume [MTV] during nutrient drink test), gastrointestinal symptoms (by the Gastrointestinal Symptom Rating Scale), caloric intake (by food frequency questionnaire), and body weight.
Results
For the entire cohort, MTV decreased from 1,380 cc (range: 474–2,014) at baseline to 620 cc (range: 256–1,180) 2 weeks after BTA injection; decreases were statistically significant in the subjects receiving 300 U BTA (p=0.03). Average body weight loss was 4.9 (±6.3) kg after 16 weeks. Gastric emptying T1/2 was prolonged in the 300 U BTA group, but not significantly different from baseline (p=0.17). BTA injections were well tolerated without significant adverse effects.
Conclusion
EUS-guided injection of BTA into gastric muscularis propria can be performed safely with minimal adverse effects. A dose of 300 U BTA significantly enhances satiation, is associated with weight loss, and may slow gastric emptying. Further study of higher dose BTA in obese subjects is warranted.
doi:10.1007/s11695-008-9442-x
PMCID: PMC3899096  PMID: 18286347
Obesity; Endoscopic ultrasound; Botulinum toxin; Gastric emptying; Satiation
3.  NONALCOHOLIC FATTY LIVER DISEASE INCREASES RISK OF DEATH AMONG PATIENTS WITH DIABETES: A COMMUNITY-BASED COHORT STUDY 
Introduction
The significance of non-alcoholic fatty liver disease (NAFLD) among patients with diabetes is unknown. We sought to determine whether a diagnosis of NAFLD influenced mortality among a community-based cohort of patients with type 2 diabetes mellitus.
Methods
337 residents of Olmsted County, Minnesota with diabetes mellitus diagnosed between 1980–2000 were identified using the Rochester Epidemiology Project and the Mayo Laboratory Information System and followed for 10.9 ± 5.2 years (range 0.1–25). Survival was analysed using Cox proportional hazards modelling with NAFLD treated as a time-dependent covariate.
Results
Among the 337 residents, 116 were diagnosed with NAFLD 0.9 ±4.6 years after diabetes diagnosis. Patients with NAFLD were younger, and more likely to be female, and obese. Overall 99/337 (29%) patients died. In multivariate analysis to adjust for confounders, overall mortality was significantly associated with a diagnosis of NAFLD (hazard ratio [HR] 2.2; 95% confidence Interval [CI] 1.1, 4.2; p = 0.03), presence of ischemic heart disease (HR 2.3; 95% CI 1.2, 4.4), and duration of diabetes (HR per 1 year, 1.1; 95% CI 1.03, 1.2). The most common causes of death in the NAFLD cohort were malignancy (33% of deaths), liver-related complications (19% of deaths), and ischemic heart disease (19% of deaths). In adjusted multivariate models, NAFLD was borderline associated with an increased risk of dying from malignancy (HR 2.3; 95% CI 0.9, 5.9; p = 0.09), and not from cardiovascular disease (HR 0.9; 95% CI 0.3, 2.4; p = 0.81)
Conclusions
The diagnosis of NAFLD is associated with an increased risk of overall death among patients with diabetes mellitus.
doi:10.1038/ajg.2010.18
PMCID: PMC2898908  PMID: 20145609
4.  THE NATURAL HISTORY OF NONALCOHOLIC FATTY LIVER DISEASE IN CHILDREN: A FOLLOW-UP STUDY FOR UP TO 20-YEARS 
Gut  2009;58(11):1538-1544.
Objectives
The long-term prognosis of nonalcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.
Design
Retrospective longitudinal hospital-based cohort study.
Patients
Sixty-six children with NAFLD (mean age 13.9±3.9 years) were followed-up for up to 20 years with a total of 409.6 person-years of follow-up.
Results
The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidemia and/or hyperglycemia. Four children with baseline normal fasting glucose developed type II diabetes 4-11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4±28.8 months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standarized mortality ratio of 13.6 (95% CI 3.8, 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one case progressing to cirrhosis and requiring re-transplantation.
Conclusions
Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care center may be associated with a significantly shorter survival as compared to the general population.
doi:10.1136/gut.2008.171280
PMCID: PMC2792743  PMID: 19625277
NAFLD; NASH; children; prognosis; long-term survival
5.  Prospective Evaluation of Advanced Molecular Markers and Imaging Techniques in Patients With Indeterminate Bile Duct Strictures 
BACKGROUND AND AIMS
Standard techniques for evaluating bile duct strictures have poor sensitivity for detection of malignancy. Newer imaging modalities, such as intraductal ultrasound (IDUS), and advanced cytologic techniques, such as digital image analysis (DIA) and fluorescence in situ hybridization (FISH), identify chromosomal abnormalities, and may improve sensitivity while maintaining high specificity. Our aim was to prospectively evaluate the accuracy of these techniques in patients with indeterminate biliary strictures.
METHODS
Cholangiography, routine cytology (RC), intraductal biopsy, DIA, FISH, and IDUS were performed in 86 patients with indeterminate biliary strictures. Patients were stratified based on the presence or absence of primary sclerosing cholangitis (PSC).
RESULTS
RC provided low sensitivity (7–33%) but high specificity (95–100%) for PSC and non-PSC patients. The composite DIA/FISH results (when considering trisomy-7 [Tri-7] as a marker of benign disease) yielded a 100% specificity and increased sensitivity one- to fivefold in PSC patients versus RC, and two- to fivefold in patients without PSC, depending on how suspicious cytology results were interpreted. For the most difficult-to-manage patients with negative cytology and histology who were later proven to have malignancy (N = 21), DIA, FISH, composite DIA/FISH, and IDUS were able to predict malignant diagnoses in 14%, 62%, 67%, and 86%, respectively.
CONCLUSIONS
DIA, FISH, and IDUS enhance the accuracy of standard techniques in evaluation of indeterminate bile duct strictures, allowing diagnosis of malignancy in a substantial number of patients with false-negative cytology and histology. These findings support the routine use of these newer diagnostic modalities in patients with indeterminate biliary strictures.
doi:10.1111/j.1572-0241.2007.01776.x
PMCID: PMC2911775  PMID: 18477350

Results 1-5 (5)