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Biomedical subjects

M Polkowski

Publications and source records attributed to M Polkowski.

10 recordsLinked to original sources
PubMed2004

Endosonography versus helical computed tomography for locoregional staging of gastric cancer.

BACKGROUND AND STUDY AIMS: Endosonography (EUS) has been shown to be more accurate than incremental computed tomography (CT) in the local (T) and regional (N) staging of gastric carcinoma; however, EUS has never been compared with helical CT (HCT). The fifth edition of the TNM classification changed the guidelines for N-staging of gastric carcinoma. The accuracy of imaging methods in this new system remains unknown. PATIENTS AND METHODS: Staging accuracy of EUS and HCT were compared prospectively with pathological or intraoperative findings in 88 gastric carcinoma patients. Staging was done according to the fourth and fifth editions of the TNM classification. EUS was done with a radial echo endoscope, and HCT with a scanner with two rows of detectors (two-phase contrast-enhanced scanning of a water-filled stomach). RESULTS: The T-staging accuracy of EUS (63 %, CI 52 - 73 %) was superior to the accuracy of HCT (44 %, CI 34 - 55 %; P = 0.021). N-staging accuracy of both methods was similar when the fourth edition of the TNM classification was used (EUS 47 %, CI 34 - 60 %; HCT 52 %, CI 38 - 65 %). However, HCT was more accurate than EUS when the fifth edition of the classification was applied (EUS 30 %, CI 18 - 43 %, HCT 47 %, CI 34 - 60 %; P = 0.044). The accuracy of detection of lymph node metastases was similar for both methods (EUS 67 %, CI 54 - 78 %; HCT 77 %, CI 64 - 86 %). CONCLUSIONS: EUS is more accurate than HCT in the T-staging of gastric carcinoma. Both methods are comparable for N-staging, when this is done according to the older, fourth edition of the TNM classification. If the fifth edition is used, EUS is less accurate than HCT.

Adenocarcinoma↗
PubMed2003

Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study.

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate prospectively the long-term outcomes of using argon plasma coagulation (APC) as an adjunct to piecemeal polypectomy of large sessile colorectal adenomas. PATIENTS AND METHODS: A total of 77 patients with 82 sessile colorectal adenomas (median size 2.9 cm, range 1.5 - 8.0 cm) underwent snare piecemeal polypectomy. Patients in whom polypectomy was complete received no further treatment (polypectomy group; n = 14). When polypectomy was incomplete, additional treatment with APC was started either immediately or 1 - 3 months after the last polypectomy session (polypectomy + APC group; n = 63). Patients were followed (by endoscopy and biopsy) at regular intervals. RESULTS: Histologically proven adenoma eradication was achieved in 100 % of patients (14/14) in the polypectomy group and in 90 % of patients (57/63) in the polypectomy + APC group (two patients died of unrelated causes before adenoma was eradicated, two underwent operation because cancer was detected in the polyp treated, and two underwent operation because of endoscopic treatment failure). The adenoma recurrence rate was 14 % in both the polypectomy and polypectomy + APC groups. All recurrences except one occurred during the first year of follow-up and all were successfully re-treated endoscopically. A total of 69 patients in whom long-term follow-up data are available are free from adenoma at a median follow-up of 37 months (range 12 - 80). No major complications of endoscopic treatment occurred. In seven cases (9 %) the polyp was eventually shown to be malignant; in two of these patients the diagnosis of cancer was delayed as a result of unsuccessful endoscopic treatment. CONCLUSIONS: APC used in combination with piecemeal polypectomy of large colorectal adenomas is an effective and safe method of therapy, provided patient selection is careful and follow-up close.

Adenomatous Polyposis Coli↗
PubMed2003

Endoscopic ultrasonography for prediction of postpolypectomy bleeding in patients with large nonpedunculated rectosigmoid adenomas.

BACKGROUND AND STUDY AIMS: Case reports suggest that endosonographic visualization of blood vessels in a gastric polyp may be predictive of risk of postpolypectomy bleeding; however, this issue has never been studied in patients with colorectal adenomas. PATIENTS AND METHODS: Endosonography (EUS) was performed prior to endoscopic polypectomy of 42 large (>/= 20 mm) nonpedunculated adenomatous polyps. The median diameter of the polyps was 30 mm (range 20-100 mm); 35 were located in the rectum and seven in the sigmoid colon. During EUS both the polyp and the bowel wall underneath were searched for the presence of vessels, which were defined as longitudinal/tortuous or round/oval echo-free structures >/= 2 mm in diameter. RESULTS: The polyp was visualized adequately in 39 cases; three cases were excluded from analysis due to inadequate visualization. In eight polyps (20.5%, group 1) EUS revealed vessels measuring 2-4 mm; in 31 polyps (79.5 %, group 2) no vessels were found. The postpolypectomy bleeding incidence (per polyp treated) was 12.5% in group 1 and 12.9 % in group 2 (P>0.05). CONCLUSIONS: In this small series of patients with large nonpedunculated rectosigmoid adenomas, the EUS image of the polyp was not predictive of postpolypectomy bleeding. The detection of vessels on EUS did not increase the risk for bleeding; however, the sample size was to small to draw definite conclusions. The absence of vessels on EUS did not rule out the possibility of bleeding.

Adenoma↗
PubMed2002

Transabdominal ultrasound for visualizing gastric submucosal tumors diagnosed by endosonography: can surveillance be simplified?

BACKGROUND AND STUDY AIMS: Management options for gastric submucosal tumors (SMTs) include tumor removal or surveillance. If the latter is chosen, it requires repeated measurements of the tumor diameter. Although this can be achieved using endoscopy or endosonography (EUS), a less invasive and cheaper method would be welcome. The aim of this prospective study was to assess the proportion of gastric SMTs that can be visualized using transabdominal ultrasound of the water-filled stomach. PATIENTS AND METHODS: Fifty-one consecutive patients with endosonographically diagnosed gastric SMTs underwent transabdominal ultrasound examinations of the water-filled stomach performed immediately after EUS; both procedures were carried out by the same investigator. Transabdominal ultrasound was considered positive only if: firstly, the tumor was visualized unequivocally; secondly, its dimensions could be measured; and thirdly, photographic documentation could be recorded. In each case, a positive result had to be confirmed by an independent investigator, who reviewed the photographic documentation. RESULTS: The median size of SMTs on EUS was 25 mm (range 4 - 55 mm). Twelve tumors were located in the antrum, 25 in the gastric body, and 14 in the gastric fundus or cardia. Transabdominal ultrasound demonstrated the tumor in 35 of 51 patients (69 %). For tumors < or = 30 mm, the visualization rate was 61 % (22 of 36). The location of the tumor and its EUS features did not significantly affect the sensitivity of transabdominal ultrasound. CONCLUSIONS: In 69 % of patients with endosonographically diagnosed gastric SMTs, the tumor can also be visualized (and measured) using transabdominal ultrasound of the water-filled stomach. This noninvasive and inexpensive method may potentially be useful for surveillance in patients with SMTs, and further evaluation in this setting is warranted.

Adult↗
PubMed1999

Helical computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients.

BACKGROUND: Helical computed tomography performed after intravenous administration of a cholangiographic contrast material (HCT-cholangiography) may be useful for detecting bile duct stones in non-jaundiced patients. However, this method has never been compared with other non-invasive biliary imaging tests. AIMS: To compare prospectively HCT-cholangiography and endosonography (EUS) in a group of non-jaundiced patients with suspected bile duct stones. METHODS: Fifty two subjects underwent both HCT-cholangiography and EUS. Endoscopic retrograde cholangiography (ERCP), with or without instrumental bile duct exploration, served as a reference method, and was successful in all but two patients. RESULTS: Thirty four patients (68%) were found to have choledocholithiasis at ERCP. The sensitivity for HCT-cholangiography in stone detection was 85%, specificity 88%, and accuracy 86%. For EUS the sensitivity was 91%, specificity 100%, and accuracy 94%. The differences were not significant. No serious complications occurred with either method. CONCLUSIONS: HCT-cholangiography and EUS are safe and comparably accurate methods for detecting bile duct stones in non-jaundiced patients.

Adult↗
PubMedDate not supplied

Building and growing a hospital intranet: a case study.

BACKGROUND: The Intranet is a rapidly evolving technology in large hospitals. In this paper, we describe the first phase of an Intranet project in a multi-hospital system in New York City. OBJECTIVES: (1) To encourage the use of the Intranet among physicians, nurses, managers, and other associates in a multi-hospital system; and (2) to build the Intranet in a cost-effective manner using existing resources. METHODS: A WebTrends Log Analyzer assessed the Intranet use in terms of the number of accesses from each department. RESULTS: A broad range of features, including medical knowledge resources, clinical practice guidelines, directions, patient education, online forms, phone directory, and discussion forums were developed. Analysis of more than 890,000 hits revealed the departments with hits greater than 1,000 were the Library (6,130), Physicians Gateway (2,539), Marketing (1,321), Information Systems (1,241), and Nutrition (1,221). Of 819 unique visitors, 74 per cent visited more than once. CONCLUSIONS: It is possible to create and diffuse an Intranet in a multi-hospital system in a cost-effective manner. However, the key challenges were selling the potential of this new technology to opinion leaders and other stakeholders, and converting pre-existing printed content by obtaining word processed and image files from other departments or contracted print publishers.

Computer Communication Networks↗