Background and aims: This prospective trial was designed to compare the performance characteristics of five different screening tests in parallel for the detection of advanced colonic neoplasia: CT colonography (CTC), colonoscopy (OC), flexible sigmoidoscopy (FS), faecal immunochemical stool testing (FIT) and faecal occult blood testing (FOBT). Methods: Average risk adults provided stool specimens for FOBT and FIT, and underwent same-day low-dose 64-multidetector row CTC and OC using segmentally unblinded OC as the standard of reference. Sensitivities and specificities were calculated for each single test, and for combinations of FS and stool tests. CTC radiation exposure was measured, and patient comfort levels and preferences were assessed by questionnaire. Results: 221 adenomas were detected in 307 subjects who completed CTC (mean radiation dose, 4.5 mSv) and OC; 269 patients provided stool samples for both FOBT and FIT. Sensitivities of OC, CTC, FS, FIT and FOBT for advanced colonic neoplasia were 100% (95% CI 88.4% to 100%), 96.7% (82.8% to 99.9%), 83.3% (95% CI 65.3% to 94.4%), 32% (95% CI 14.9% to 53.5) and 20% (95% CI 6.8% to 40.7%), respectively. Combination of FS with FOBT or FIT led to no relevant increase in sensitivity. 12 of 45 advanced adenomas were smaller than 10 mm. 46% of patients preferred CTC and 37% preferred OC (p,0.001). Conclusions: High-resolution and low-dose CTC is feasible for colorectal cancer screening and reaches sensitivities comparable with OC for polyps .5 mm. For patients who refuse full bowel preparation and OC or CTC, FS should be preferred over stool tests. However, in cases where stool tests are performed, FIT should be recommended rather than FOBT.Colorectal cancer is one of the major public health issues in industrialised countries. Most colorectal cancers are thought to originate from benign adenomatous polyps that develop over a period of many years.1 Early detection followed by removal of adenomas has been shown to reduce incidence and colorectal cancer-related mortality.2 3Therefore, screening of the asymptomatic and average risk population is recommended by many organisations and expert panels, and is reimbursed by insurance companies in several countries. 4-7Next to colonoscopy, flexible sigmoidoscopy (FS) and guaiac-based faecal occult blood test (FOBT) are widely applied screening procedures which have been compared prospectively with each other. Colonoscopy has been found to be the screening test with the highest sensitivity and outperforms FS and FOBT which miss a significant number of relevant adenomas. 8 Colonoscopy, however, is not a perfect test in itself, and misses 6-12% of large adenomas. 9-11CT colonography (CTC), also known as virtual colonoscopy, and faecal immunochemical tests (FITs) have been proposed as screening tests for colonic neoplasia.12-14 They have at present not been integrated into screening programmes. Based on recent research, CTC shows heterogeneous results in the detection of colonic polyps: some studies demonstrated high sen...

1. After oral administration of aristolochic acid I (AAI) and aristolochic acid II (AAII) to rats, the following metabolites were isolated from the urine and their structures elucidated: aristolactam I, aristolactam Ia, aristolochic acid Ia, aristolic acid I and 3,4-methylenedioxy-8-hydroxy-1-phenanthrenecarboxylic acid (metabolites of AAI); or aristolactam Ia, aristolactam II and 3,4-methylenedioxy-1-phenanthrenecarboxylic acid (metabolites of AAII). A further metabolite of AAII having a lactam structure has not yet been isolated in pure form. 2. The metabolic pathways have been elucidated by administration of various metabolites. 3. The principal metabolite of AAI in rats was aristolactam Ia; 46% of the dose was excreted in the urine in form of this metabolite and 37% in the faeces. The other substances were minor metabolites. Those metabolites of AAII whose structures have been elucidated were minor metabolites; the largest proportion consisted of aristolactam II, which accounted for 4.6% in the urine and 8.9% in the faeces. 4. The mouse was the only animal which had the same metabolite patterns of AAI and AAII as those found in the rat. Not all the metabolites listed above were found in urine from guinea pigs, rabbits, dogs and man.

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Die Titelverbindungen 4 werden durch N‐7‐Dealkylierung der 2‐Furanylmethyl‐, 2‐Thiophenylmethyl‐, oder 1‐Phenylethyl‐Gruppe aus den Derivaten 2a – g und 10a – j mit Polyphosphoräure erhalten. Im Gegensatz zur 2‐Furanylmethyl‐Gruppe lassen sich die 2‐Thiophenylmethyl‐ und 1‐Phenylethyl‐Gruppen unabhängig von der Substitution am Heterobicyclus entfernen.

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Es wird eine einfache Synthese f i r 2-Amino-3-cyano-pyrrole beschrieben, die in der Kondensa tion von a-Hydroxyketonen, primaren Aminen und Malonitril besteht.Synthesis of 2-Amino-3-cyano-pyrroles A simple synthesis for 2-amino-3-cyano-pyrroles is described: condensation of a-hydroxyketones, primary amines and malonitrile.In fruheren Arbeiten' -4 ) befaf3ten wir uns mit Kondensationen von a-Hydroxyketonen, primaren Aminen und Ketonen bzw. 0-Diketonen als acide Komponenten, die zur Darstellung substituierter Pyrrole geeignet waren (Gleichung 1).In dieser Mitteilung wird uber die Verwendung von Malonitril als acide Komponente berichtet. Der Unterschied gegenuber den vorgenannten Reaktionen (Gleichung 1) besteht darin, daf3 es sich hier um eine Anlagerung und Kondensation handelt (Gleichung 2), wahrend es vorher reine Kondensationsschritte waren.