Biomedical subjects
Publications and source records attributed to J D Waye.
A 76-year-old female presented with bright red rectal bleeding. Endoscopic evaluation revealed a polypoid lesion sprouting hair in the sigmoid colon. Histologically the resected polyp was composed of elements of all three germ layers, fulfilling the criteria for a teratoma. The differential diagnosis of this benign polyp and its significance are discussed.
A 69-yr-old white female presented to her physician with a 3-yr history of epigastric pain. Gastric biopsies revealed noncaseating granulomas in the mucosa and submucosa. No definite etiological factor could be detected. A diagnosis of idiopathic granulomatous gastritis was made. In the past, this condition has prompted surgery. Steroids have also been advocated. Our patient was managed successfully with symptomatic treatment, without the use of steroids or surgical intervention. She remains well 4 yr later.
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We evaluated the use of percutaneous endoscopic gastrostomy in 30 ICU patients. There was a 14% incidence of minor complications, no major complications, and no mortality. We conclude that percutaneous endoscopic gastrostomy is a useful alternative to operative gastrostomy in the ICU patient.
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A patient with traumatic hemobilia documented by retrograde endoscopic cholangiography and treated by right hepatic artery ligation, is described. The role of ERCP in making the diagnosis of traumatic hemobilia is discussed.
Colonoscopy has added a new dimension to the diagnosis of colonic diseases. In the field of inflammatory bowel disease, colonscopy is indicated only when certain specific problems arise. Patients with acute colitis and those who are too sick to withstand cleansing enemas should not undergo colonoscopy. A major use of the colonoscope is in the detection of carcinoma in the colitic colon either in the form of colonic strictures or filling defects discovered by barium enema x-ray, or in the long-term surveillance of patients with universal ulcerative colitis. Criteria are listed to assist in the colonoscopic differential diagnosis between ulcerative and granulomatous colitis. By using different criteria than the radiographer, and with the help of biopsy specimens, a high degree of accuracy in proper diagnosis can be achieved.
We studied 258 patients with rectal bleeding and 46 patients with anemia and occult blood in the stool. All 304 patients had negative proctosigmoidoscopies, single-contrast barium studies that were negative or showed diverticula only, and colonoscopic evaluation. In the 258 patients, the overall incidence of finding significant lesions by colonoscopy was 41.5%. Twenty-nine patients (11.2%) had carcinoma and 17 patients (6.6%) had cecal telangiectasia. In the 46 patients, the overall incidence of finding significant lesions was 19.6%. Three patients with carcinoma were found in this group. A significant number of both benign and malignant lesions were detected by colonoscopy proximal to the splenic flexure. Colonoscopy should be done in patients with rectal bleeding or anemia and occult blood in the stool who have had negative proctosigmoidoscopies and single-contrast barium studies interpreted as normal or showing diverticula.
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Fifty-two patients with or without pancreatic disease were studied with both secretin test and endoscopic retrograde pancreatography. Pancreatic histopathology was obtained by exploratory laparotomy in half of these patients. The following conclusions were reached: 1. Secretory tests are the most sensitive indicators of chronic pancreatitis, although not all cases of chronic pancreatitis will be discovered by this test. 2. When secretory tests show low volume output, pancreatography is crucial in differentiating between malignant ductal obstruction or pancreatic replacement by fibrosis or atrophy. 3. Histologic correlation with ductular structure and/or secretin function is frequently discordant. 4. The secretin test and pancreatogram measure different parameters and the use of both these complementary studies will lead to increased diagnostic accuracy and better understanding of pancreatic pathophysiology.
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Carcinoma of the colon usually starts as a small nidus of malignant cells on the tip of adenomatous/villous polyps. The term "early cancer of the colon" is introduced as part of the concept that there are stages in the development of colon cancer and that it can and should be treated at an early stage. Removal of polyps at any point in their development up to the stage of early invasiveness represents the most favorable time for resection and cure.