Treatment of severe esophageal Crohn's disease with thalidomide.
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I Hanan
Publications and source records attributed to I Hanan.
CT colonography with three-dimensional problem solving for detection of colonic polyps.
OBJECTIVE: We performed CT colonography in patients referred for conventional colonoscopy, interpreted the axial images, and used commercially available software to reconstruct endoluminal perspective views to differentiate polyps from folds. SUBJECTS AND METHODS: We prospectively examined 44 patients (27 men and 17 women; mean age, 58 years old) with CT colonography by interpreting the axial images and using three-dimensional rendering for problem solving only. The CT scans were interpreted by two radiologists who were unaware of patients' histories as revealed by colonoscopic findings. The findings on colonography were compared with those of conventional colonoscopy to determine sensitivity, specificity, time spent on interpretation, and confidence of interpretation. RESULTS: Colonoscopy showed normal findings in 28 patients and 22 polyps in the remaining 16 patients. Six polyps were 8 mm or larger, three were 5-7 mm, and 13 were 5 mm or smaller. The findings of the two observers revealed an overall sensitivity of 50% and 38%, respectively, and a specificity of 93% and 86%, respectively. Sensitivity for polyps larger than 8 mm was 83% and specificity was 100% for both observers. The average amount of time spent on interpretation was 28 min 30 sec (range, 14-65 min). Both observers used the endoluminal view for differentiating folds from polyps in 23 (52%) of 44 patients, which had only minimal impact on interpretation time. CONCLUSION: CT colonography can be performed and the images interpreted using currently available hardware and software by initially using the axial images to search for polyps of significant size. Endoluminal views should be used only when necessary to help distinguish normal folds from fixed raised lesions that are suggestive of polyps.
Colonic Polyps↗
"Mother-baby" biliary endoscopy: the University of Chicago experience.
OBJECTIVE: The "mother-baby" technique of peroral cholangioscopy is a relatively recent development in biliary endoscopy and permits direct visualization of the biliary tree. This paper presents the experience of one institution with this new technique. METHODS: We used the Olympus mother-baby endoscopy system at the University of Chicago and at one of its affiliated hospitals to examine and treat selected lesions in the biliary tree that had eluded successful diagnosis or treatment by standard means. In addition, we used the baby endoscope alone through surgically created percutaneous tracts to treat selected patients with retained stones. RESULTS: From July 1990 to June 1993, peroral cholangioscopy was performed 18 times in 12 patients at the University of Chicago and affiliated hospitals. The baby endoscope was successfully passed into the bile duct in 15 of 18 cases (83.3%). Additionally, the baby endoscope alone was used through a T-tube or cholecystostomy tract 10 times in six patients. Complications occurred in two patients and were minor; there were no fatalities. With refinement of technique, successful passage of the baby endoscope was accomplished in 100% of patients undergoing peroral cholangioscopy. CONCLUSIONS: Direct visualization of the biliary tree with the ability to sample (brush, biopsy) or treat (basket removal, electrohydraulic or laser lithotripsy) lesions significantly aided in the care of all patients in whom the baby endoscope was successfully passed by providing the correct diagnosis and, when appropriate, by allowing definitive treatment of lesions. The eventual role of this technique in the current cost-conscious climate is unclear, but at present it should be limited to selected referral centers.
Adult↗