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  1. Article: The in-patient colonoscopy: a difficult endeavor.

    Enns, Robert / Krygier, Darin

    Canadian journal of gastroenterology = Journal canadien de gastroenterologie

    2008  Volume 22, Issue 11, Page(s) 900–902

    MeSH term(s) Colonic Diseases/diagnosis ; Colonoscopy/methods ; Diagnosis, Differential ; Humans ; Inpatients ; Patient Selection ; Reproducibility of Results
    Language English
    Publishing date 2008-08-22
    Publishing country Canada
    Document type Journal Article ; Review
    ZDB-ID 639439-5
    ISSN 1916-7237 ; 0835-7900
    ISSN (online) 1916-7237
    ISSN 0835-7900
    DOI 10.1155/2008/826271
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: The inpatient colonoscopy: a worthwhile endeavour.

    Krygier, Darin / Enns, Robert

    Canadian journal of gastroenterology = Journal canadien de gastroenterologie

    2008  Volume 22, Issue 12, Page(s) 977–979

    MeSH term(s) Appointments and Schedules ; Colonoscopy/methods ; Hospitalization ; Humans ; Inpatients ; Preoperative Care
    Language English
    Publishing date 2008-09-24
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 639439-5
    ISSN 1916-7237 ; 0835-7900
    ISSN (online) 1916-7237
    ISSN 0835-7900
    DOI 10.1155/2008/576987
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: How to manage difficult Crohn's disease: optimum delivery of anti-TNFs.

    Krygier, Darin S / Ko, Hin Hin / Bressler, Brian

    Expert review of gastroenterology & hepatology

    2009  Volume 3, Issue 4, Page(s) 407–415

    Abstract: Crohn's disease is a chronic inflammatory condition that can involve any portion of the GI tract, leading to disabling symptoms and complications. Standard treatment with 5-aminosalicylic acid, antibiotics, corticosteroids and immunosuppressives has ... ...

    Abstract Crohn's disease is a chronic inflammatory condition that can involve any portion of the GI tract, leading to disabling symptoms and complications. Standard treatment with 5-aminosalicylic acid, antibiotics, corticosteroids and immunosuppressives has limited efficacy and is associated with serious potential adverse events. The anti-TNF-alpha agents are effective in the induction and maintenance of remission in luminal and fistulizing Crohn's disease. Recent evidence suggests that early treatment with anti-TNF agents and immunosuppressives may alter the natural history of the disease and prevent late complications. In those patients who have lost response to, or are intolerant of, a single anti-TNF agent, increasing the dose of the medication or switching to alternate biologic agents, such as another anti-TNF drug or natalizumab, have been shown to be effective treatments.
    MeSH term(s) Adalimumab ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/adverse effects ; Anti-Inflammatory Agents/therapeutic use ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized ; Certolizumab Pegol ; Crohn Disease/drug therapy ; Crohn Disease/immunology ; Crohn Disease/pathology ; Drug Resistance ; Drug Therapy, Combination ; Gastrointestinal Agents/administration & dosage ; Gastrointestinal Agents/adverse effects ; Gastrointestinal Agents/therapeutic use ; Humans ; Immunoglobulin Fab Fragments/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Infliximab ; Intestinal Mucosa/drug effects ; Intestinal Mucosa/immunology ; Intestinal Mucosa/pathology ; Polyethylene Glycols/therapeutic use ; Treatment Outcome ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; Wound Healing/drug effects
    Chemical Substances Anti-Inflammatory Agents ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Gastrointestinal Agents ; Immunoglobulin Fab Fragments ; Immunosuppressive Agents ; Tumor Necrosis Factor-alpha ; Polyethylene Glycols (30IQX730WE) ; Infliximab (B72HH48FLU) ; Adalimumab (FYS6T7F842) ; Certolizumab Pegol (UMD07X179E)
    Language English
    Publishing date 2009-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2481021-6
    ISSN 1747-4132 ; 1747-4124
    ISSN (online) 1747-4132
    ISSN 1747-4124
    DOI 10.1586/egh.09.25
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Clozapine-induced fatal fulminant hepatic failure: a case report.

    Chang, Albert / Krygier, Darin S / Chatur, Nazira / Yoshida, Eric M

    Canadian journal of gastroenterology = Journal canadien de gastroenterologie

    2009  Volume 23, Issue 5, Page(s) 376–378

    Abstract: Fulminant hepatic failure (FHF) refers to the rapid development of severe acute liver injury with impaired synthetic function and encephalopathy in a person who previously had a normal liver or had wellcompensated liver disease. The potential causes of ... ...

    Abstract Fulminant hepatic failure (FHF) refers to the rapid development of severe acute liver injury with impaired synthetic function and encephalopathy in a person who previously had a normal liver or had wellcompensated liver disease. The potential causes of FHF are numerous, but viral or toxin-induced hepatitis are the most common. Clozapineinduced hepatotoxicity has rarely been reported in the literature, occurs via an unknown mechanism and results in liver biochemical abnormalities that are usually of no clinical significance. In approximately 30% to 50% of patients treated with clozapine, there is an asymptomatic rise in serum aminotransaminase levels; however, there are no current guidelines for routine monitoring of liver function tests and liver enzymes during its use. Fatal fulminant hepatitis has only been reported in three patients receiving clozapine. A case of fatal FHF that occurred in a schizophrenic woman who began clozapine therapy shortly before her illness developed is described.
    MeSH term(s) Antipsychotic Agents/adverse effects ; Clozapine/adverse effects ; Diagnosis, Differential ; Fatal Outcome ; Female ; Humans ; Liver Failure, Acute/chemically induced ; Liver Failure, Acute/diagnosis ; Middle Aged ; Schizophrenia, Paranoid/drug therapy
    Chemical Substances Antipsychotic Agents ; Clozapine (J60AR2IKIC)
    Language English
    Publishing date 2009-05-18
    Publishing country Canada
    Document type Case Reports ; Journal Article
    ZDB-ID 639439-5
    ISSN 1916-7237 ; 0835-7900
    ISSN (online) 1916-7237
    ISSN 0835-7900
    DOI 10.1155/2009/503916
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: The impact of patient education on the quality of inpatient bowel preparation for colonoscopy.

    Rosenfeld, Greg / Krygier, Darin / Enns, Robert A / Singham, Janakie / Wiesinger, Holly / Bressler, Brian

    Canadian journal of gastroenterology = Journal canadien de gastroenterologie

    2010  Volume 24, Issue 9, Page(s) 543–546

    Abstract: Background: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.: Objectives: To assess the impact of patient education, in the form of both counselling and written instructions, ...

    Abstract Background: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.
    Objectives: To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.
    Methods: A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.
    Results: The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).
    Conclusion: Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.
    MeSH term(s) Aged ; Cathartics/administration & dosage ; Colonoscopy/methods ; Directive Counseling/methods ; Female ; Humans ; Male ; Patient Education as Topic/methods
    Chemical Substances Cathartics
    Language English
    Publishing date 2010-11-30
    Publishing country Canada
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 639439-5
    ISSN 1916-7237 ; 0835-7900
    ISSN (online) 1916-7237
    ISSN 0835-7900
    DOI 10.1155/2010/718628
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: The Soma of RPeD1 must be present for long-term memory formation of associative learning in Lymnaea.

    Scheibenstock, Andi / Krygier, Darin / Haque, Zara / Syed, Naweed / Lukowiak, Ken

    Journal of neurophysiology

    2002  Volume 88, Issue 4, Page(s) 1584–1591

    Abstract: The cellular basis of long-term memory (LTM) storage is not completely known. We have developed a preparation where we are able to specify that a single identified neuron, Right Pedal Dorsal 1 (RPeD1), is a site of LTM formation of associative learning ... ...

    Abstract The cellular basis of long-term memory (LTM) storage is not completely known. We have developed a preparation where we are able to specify that a single identified neuron, Right Pedal Dorsal 1 (RPeD1), is a site of LTM formation of associative learning in the pond snail, Lymnaea stagnalis. We demonstrated this by ablating the soma of the neuron but leaving behind its functional primary neurite, as evidenced by electrophysiological and behavioral analyses. The soma-less RPeD1 neurite continues to be a necessary participant in the mediation of aerial respiratory behavior, associative learning, and intermediate-term memory (ITM); however, LTM cannot be formed. However, if RPeD1's soma is ablated after LTM consolidation has occurred, LTM can still be accessed. Thus the soma of RPeD1 is a site of LTM formation.
    MeSH term(s) Animals ; Association Learning/physiology ; Conditioning, Operant/physiology ; Denervation ; Lymnaea ; Memory/physiology ; Neurites/physiology ; Neurons/physiology ; Neurons/ultrastructure ; Respiration
    Language English
    Publishing date 2002-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80161-6
    ISSN 1522-1598 ; 0022-3077
    ISSN (online) 1522-1598
    ISSN 0022-3077
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Parvovirus B19 induced hepatic failure in an adult requiring liver transplantation.

    Krygier, Darin S / Steinbrecher, Urs P / Petric, Martin / Erb, Siegfried R / Chung, Stephen W / Scudamore, Charles H / Buczkowski, Andrzej K / Yoshida, Eric M

    World journal of gastroenterology

    2009  Volume 15, Issue 32, Page(s) 4067–4069

    Abstract: Parvovirus B19 induced acute hepatitis and hepatic failure have been previously reported, mainly in children. Very few cases of parvovirus induced hepatic failure have been reported in adults and fewer still have required liver transplantation. We report ...

    Abstract Parvovirus B19 induced acute hepatitis and hepatic failure have been previously reported, mainly in children. Very few cases of parvovirus induced hepatic failure have been reported in adults and fewer still have required liver transplantation. We report the case of a 55-year-old immunocompetent woman who developed fulminant hepatic failure after acute infection with Parvovirus B19 who subsequently underwent orthotopic liver transplantation. This is believed to be the first reported case in the literature in which an adult patient with fulminant hepatic failure associated with acute parvovirus B19 infection and without hematologic abnormalities has been identified prior to undergoing liver transplantation. This case suggests that Parvovirus B19 induced liver disease can affect adults, can occur in the absence of hematologic abnormalities and can be severe enough to require liver transplantation.
    MeSH term(s) Acute Disease ; DNA, Viral/metabolism ; Female ; Hepatitis/therapy ; Hepatitis/virology ; Humans ; Liver Failure, Acute/therapy ; Liver Failure, Acute/virology ; Liver Transplantation/methods ; Middle Aged ; Parvoviridae Infections/therapy ; Parvoviridae Infections/virology ; Parvovirus B19, Human/metabolism ; Polymerase Chain Reaction ; Treatment Outcome
    Chemical Substances DNA, Viral
    Language English
    Publishing date 2009-08-25
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.15.4067
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: The use of budesonide in the treatment of autoimmune hepatitis in Canada.

    Zandieh, Iman / Krygier, Darin / Wong, Victor / Howard, John / Worobetz, Lawrence / Minuk, Gerald / Witt-Sullivan, Helga / Yoshida, Eric M

    Canadian journal of gastroenterology = Journal canadien de gastroenterologie

    2008  Volume 22, Issue 4, Page(s) 388–392

    Abstract: Background: Autoimmune hepatitis (AIH) is a chronic inflammatory disease that is successfully treated with prednisone and/or azathioprine immunosuppressive therapy in 70% to 80% of patients. The remaining patients are intolerant or refractory to these ... ...

    Abstract Background: Autoimmune hepatitis (AIH) is a chronic inflammatory disease that is successfully treated with prednisone and/or azathioprine immunosuppressive therapy in 70% to 80% of patients. The remaining patients are intolerant or refractory to these standard medications. Budesonide, a synthetic glucocorticoid, undergoes a high degree of first-pass metabolism, reducing its systemic bioavailability, and has a 15-fold greater affinity for the glucocorticoid receptor than prednisolone. Budesonide may be a potentially useful systemic steroid-sparing immunosuppressive agent in the treatment of AIH.
    Objective: To review the Canadian experience using budesonide to treat AIH.
    Methods: Patients with AIH currently or previously treated with budesonide were identified through the Canadian Association for the Study of the Liver membership. Data were collected regarding their clinical and treatment history.
    Results: A total of nine patients were identified. All patients were female, with an average age of 39 years (range 12 to 66 years). The indications for budesonide were adverse side effects of prednisone in two patients, noncompliance with prednisone and azathioprine in one patient and intolerance to azathioprine resulting in prednisone dependence in the remaining six patients. Patients were treated in doses ranging from 9 mg daily to 3 mg every other day for 24 weeks to eight years. Seven of nine patients had a complete response, defined as sustained normalization of the aminotransferase levels. The remaining two patients were classified as nonresponders (less than a 50% reduction in pretreatment aminotransferase levels).
    Conclusions: In Canada, budesonide has been successfully used in seven of nine patients with autoimmune hepatitis who were either intolerant to prednisone and azathioprine or prednisone-dependent. No adverse effects were reported with budesonide. Budesonide is potentially a valuable treatment option for AIH patients refractory or intolerant to standard therapy, and is deserving of further study.
    MeSH term(s) Adolescent ; Adult ; Aged ; Alanine Transaminase/blood ; Budesonide/therapeutic use ; Canada ; Child ; Female ; Glucocorticoids/therapeutic use ; Hepatitis, Autoimmune/blood ; Hepatitis, Autoimmune/drug therapy ; Humans ; Middle Aged ; Retrospective Studies ; Treatment Outcome
    Chemical Substances Glucocorticoids ; Budesonide (51333-22-3) ; Alanine Transaminase (EC 2.6.1.2)
    Language English
    Publishing date 2008-04-16
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 639439-5
    ISSN 1916-7237 ; 0835-7900
    ISSN (online) 1916-7237
    ISSN 0835-7900
    DOI 10.1155/2008/509459
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Does training and experience influence the accuracy of computed tomography colonography interpretation?

    Rosenfeld, Greg / Fu, Yi Tzu Nancy / Quiney, Brendan / Qian, Hong / Krygier, Darin / Brown, Jacquie / Vos, Patrick / Tiwari, Pari / Telford, Jennifer / Bressler, Brian / Enns, Robert

    World journal of gastroenterology

    2012  Volume 20, Issue 6, Page(s) 1574–1581

    Abstract: Aim: To evaluate the effect of experience on the accuracy rate of computed tomography colonography (CTC) interpretation and patient preferences/satisfaction for CTC and colonoscopy.: Methods: A prospective, non-randomized, observational study ... ...

    Abstract Aim: To evaluate the effect of experience on the accuracy rate of computed tomography colonography (CTC) interpretation and patient preferences/satisfaction for CTC and colonoscopy.
    Methods: A prospective, non-randomized, observational study performed in a single, tertiary care center involving 90 adults who underwent CTC followed by colonoscopy on the same day. CTC was interpreted by an abdominal imaging radiologist and then a colonoscopy was performed utilizing segmental un-blinding and re-examination as required. A radiology resident and two gastroenterology (GI) fellows blinded to the results also interpreted the CTC datasets independently. Accuracy rates and trend changes were determined for each reader to assess for a learning curve.
    Results: Among 90 patients (57% male) aged 55 ± 8.9 years, 39 polyps ≥ 6 mm were detected in 20 patients and 13 polyps > 9 mm in 10 patients. Accuracy rates were 88.9% (≥ 6 mm) and 93.3% (> 9 mm) for the GI Radiologist, 89.8% (≥ 6 mm) and 98.9% (> 9 mm) for the Radiology Resident and 86.7% and 95.6% (≥ 6 mm) and 87.8% and 94.4% (> 9 mm) for each of the GI fellows respectively. The reader's accuracy rate did not change significantly with the percentage change rate ranging between -1.7 to 0.9 (P = 0.12 to 0.56). Patients considered colonoscopy more satisfactory than CTC (30% vs 4%, P < 0.0001), they felt less anxiety during colonoscopy (36% vs 7%, P < 0.0001), they experienced less pain or discomfort during colonoscopy compared to CTC (69% vs 4%, P < 0.0001) and colonoscopy was preferred by 77% of the participants as a repeat screening test for the future.
    Conclusion: No statistically significant learning curve was identified in CTC interpretation suggesting that further study is required to identify the necessary training to adequately interpret CTC scans.
    MeSH term(s) Adult ; Aged ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; False Positive Reactions ; Female ; Gastroenterology/education ; Humans ; Learning Curve ; Male ; Middle Aged ; Patient Preference ; Prospective Studies ; Regression Analysis ; Reproducibility of Results ; Surveys and Questionnaires
    Language English
    Publishing date 2012-08-17
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v20.i6.1574
    Database MEDical Literature Analysis and Retrieval System OnLINE

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