Assurance for Endurance? Introducing a Novel Ergonomics Curriculum to Reduce Pain and Enhance Physical Well-Being Among GI Fellows

Musculoskeletal pain and injuries (MSKPI) are common among gastroenterologists (GI) and GI fellows. Common areas of pain include the back, neck, hands/fingers, shoulders, and elbows. Although the prevalence of career-related pain and injuries among GIs is high, few endoscopists receive training in how to prevent MSKPI. We developed an ergonomics curriculum for our GI fellows that consisted of two modules that were led by physical therapists. Twelve out of 15 GI fellows, and one out of two hepatology fellows, participated in Module 1. Prior to the first module, 77% of participants reported pain in one or more body parts. Of those who reported pain, 100% of the fellows stated that this pain occurred during procedures, and 50% indicated this pain was performance-limiting. After completing Module 1, 100% of fellows reported that this was a valuable topic and 100% of the participants felt that this information would both help them feel and perform better. All fellows stated they had an immediate decrease in physical discomfort after engaging in the exercises that were included in Module 1. Eight fellows participated in Module 2. At the end of this module, 100% of fellows reported that this ergonomics training would likely help them to "physically perform better during procedures" and 100% of fellows indicated a reduction of physical discomfort (pain, aching) immediately after completing these exercises. Preliminary data indicated that this novel curriculum was perceived as valuable by GI fellows and that practicing these exercises reduced pain, particularly in the neck and the lower back.

Azathioprine in refractory sprue

We report a patient with life-threatening refractory sprue who was dependent on high doses of corticosteroids to prevent severe diarrhea, malabsorption, and villous atrophy. Azathioprine allowed tapering of corticosteroids to lower doses, while maintaining remission in histology and in objective measures of malabsorption. Immunosuppressive therapy, however, is not without risks, particularly in patients with associated hypoglobulinemia.

Ileocecal intussusception of small-bowel lymphoma: diagnosis by colonoscopy

Intussusception is rare in adults. There is little information on the role of colonoscopy in colonic intussusception. We report, to our knowledge, the first adult case of small-bowel lymphoma causing ileocecal intussusception in which the diagnosis was made by colonoscopy. Colonoscopy has a useful role in the diagnosis and management of ileocecal intussusception.

Adipsia-polydipsia induced by simultaneous lesion of the medioventral septum and anteroventral third ventricle area in the rat

The medioventral septal area (MVS) and also the tissue surrounding the periventricular preoptic-hypothalamic region (AV3V) of male rats, were destroyed by mean of electrolytic lesions. Before and after the lesions, daily water and food intakes, diuresis, body weight, urine osmolarity, and sodium and potassium excretion were determined. Rats with simultaneous AV3V-MVS lesions showed a biphasic pattern of drinking behavior characterized by a first period of adipsia followed by another period of polydipsia. During the first period of adipsia and except for the first two days, postlesion rats were able to reduce total urine volume but failed to produce an appropriate concentrated urine. During the polydipsia period, on the contrary, rats increased urine output and decreased urine osmolarity in a parallel fashion. Immediately after the lesion, food intake was decreased but recovered to pre-lesion levels gradually. By contrast, body weight was decreased during the entire period of the experiment. Sodium but not potassium excretion showed a significant increase from the 9th to the 20th day postlesion. The results suggest that the AV3V and MVS are part of a circuitry subserving the control of water intake and electrolyte balance.

Enzyme-linked immunochemical measurement of estrogen receptor in gynecologic tumors, and an overview of steroid receptors in ovarian carcinoma

We tested whether a newly available enzyme-linked immunoassay (EIA) validly measures estrogen receptor (ER) in gynecologic tumors. We first documented that ER so measured agreed with results by established radioligand-based assays [dextran-coated charcoal (DCC) and hydroxylapatite (HAP)] for in-house breast carcinomas and for proficiency testing specimens. Then, for gynecologic tumors, we found strong correlations between results for ER as measured by the two methods; e.g., for 27 ovarian carcinomas, r greater than or equal to 0.86. The same was true for ER measured in nine specimens of ovarian carcinoma from women who had undergone chemotherapy: r greater than or equal to 0.94. Radioinert estradiol or serum had no discernible effect on EIA measurements of ER, whereas our DCC assay was rendered uninterpretable. Evidently the EIA validly measures ER in steroidogenic tissues, including ovarian, and also in breast and uterine carcinomas. Clinical management of the latter is now based in part on results of steroid receptor assays. For ovarian carcinomas, ER assay can be helpful for determining the probable primary site of adenocarcinomas of unknown origin, and it is providing a rational basis for development of new diagnostic and therapeutic strategies.

Enzyme-linked immunochemical measurement of estrogen receptor in gynecologic tumors, and an overview of steroid receptors in ovarian carcinoma

We tested whether a newly available enzyme-linked immunoassay (EIA) validly measures estrogen receptor (ER) in gynecologic tumors. We first documented that ER so measured agreed with results by established radioligand-based assays [dextran-coated charcoal (DCC) and hydroxylapatite (HAP)] for in-house breast carcinomas and for proficiency testing specimens. Then, for gynecologic tumors, we found strong correlations between results for ER as measured by the two methods; e.g., for 27 ovarian carcinomas, r greater than or equal to 0.86. The same was true for ER measured in nine specimens of ovarian carcinoma from women who had undergone chemotherapy: r greater than or equal to 0.94. Radioinert estradiol or serum had no discernible effect on EIA measurements of ER, whereas our DCC assay was rendered uninterpretable. Evidently the EIA validly measures ER in steroidogenic tissues, including ovarian, and also in breast and uterine carcinomas. Clinical management of the latter is now based in part on results of steroid receptor assays. For ovarian carcinomas, ER assay can be helpful for determining the probable primary site of adenocarcinomas of unknown origin, and it is providing a rational basis for development of new diagnostic and therapeutic strategies.

[Massive pulmonary hemorrhage successfully treated with mechanical respiration and CPAP (author's transl)]

A newborn baby with massive pulmonary hemorrhage at two and a half hours of life is reported. She was successfully treated with mechanical respiration and continuous positive airway pressure. The pathogenetic mechanisms and mode of action of the applied treatment is discussed.