Biomedical subjects

Robert Sedlack

Publications and source records attributed to Robert Sedlack.

3 recordsLinked to original sources

PubMed2003

A direct comparison of ERCP teaching models.

BACKGROUND: Several teaching models for ERCP are now available. Live, anesthetized porcine models have been used for many years, but harvested porcine organ preparations have recently been developed, and computer-based endoscopy simulators now incorporate ERCP modules. Each has proven to be a useful educational modality, but there is no direct comparison among these models. This study compared the performance of these 3 ERCP teaching models. METHODS: Twenty endoscopists used each ERCP training model (computer simulator, harvested porcine organ, live anesthetized pig) and then completed a survey grading the realism and performance of each model compared with performance of ERCP in patients. A rank order was established for the models relative to their realism, educational utility, ease of use, and ease of incorporation into a training program. RESULTS: The harvested porcine organ model scored highest on indices of realism, usefulness, and performance, although this reached statistical significance only for "ease of use" (p < 0.05). Conversely, the computer simulator scored significantly lower in most realism scores, although it was felt to be the one model most easily incorporated into a training program. CONCLUSIONS: Although each ERCP teaching model has proven to be a useful training modality, the harvested porcine organ model was felt to be the most realistic as well as the most favorable model for instruction in both basic and advanced ERCP.

Adult↗

PubMed2002

Utility of EUS in the evaluation of cystic pancreatic lesions.

BACKGROUND: Preoperative differentiation of benign and malignant/potentially malignant pancreatic cystic lesions is problematic. Data to support the role of EUS and EUS-guided fine-needle aspiration (EUS-FNA) are limited. This study assessed the sensitivity, specificity, and accuracy of EUS, cytopathology, and analysis of cyst fluid for pancreatic cystic lesions. METHODS: Retrospectively, 111 consecutive patients were identified (54 men, 57 women; mean age 59 years, range 18-79 years) who underwent EUS from July 1997 to September 2000 because of known or suspected pancreatic cystic lesions based on CT or transabdominal US. Thirty-four patients (16 men, 18 women; mean age 55 years, 25-79 years) who underwent surgery formed the basis for this analysis. EUS diagnosis was compared with surgical pathology. Selected patients underwent EUS-FNA to obtain specimens for cytopathologic analysis and for determination of carcinoembryonic antigen levels. Based on surgical pathology, cysts were classified as benign (simple cyst, pseudocyst, serous cystadenoma) or malignant/potentially malignant (mucinous cystadenoma, intraductal papillary mucinous tumor, cystic islet cell tumor, cystic adenocarcinoma). RESULTS: EUS-FNA with cytopathologic assessment of cyst fluid was performed for 18 of the 34 patients; carcinoembryonic antigen level was determined in 11 cases. For EUS, cytopathology, and carcinoembryonic antigen, sensitivity was, respectively, 91%, (p = 0.01 vs. cytology), 27%, and 28%; specificity was, respectively, 60%, 100%, and 25%; and, accuracy was, respectively, 82%, 55%, and 27%. The sensitivity of EUS in all 13 patients with cystic islet cell tumor, intraductal papillary mucinous tumor, or cystic adenocarcinoma was 100%. Combining EUS, cytopathology, and carcinoembryonic antigen results did not improve accuracy. There were no complications related to the EUS or EUS-FNA. CONCLUSIONS: EUS alone is sensitive and accurate in identifying malignant/potentially malignant pancreatic cystic lesions. EUS-FNA to obtain specimens for cytopathologic analysis and determination of carcinoembryonic antigen levels, although safe, does not enhance diagnostic yield.

Adolescent↗

PubMedDate not supplied

Percutaneous endoscopic gastrostomy placement without a skin incision: results of a prospective pilot study.

Percutaneous endoscopic gastrostomy (PEG) tube placement may result in substantial skin site complications. Standard PEG (SPEG) placement involves performing a skin incision, which in our experience is not necessary. In a prospective pilot study, we examined the need for this incision with respect to placement success and stomal complications. Twenty consecutive patients underwent 20 Fr PEG tube placement by a modified technique, involving skin incision omission (IOPEG). Stoma evaluations were performed at 2 and 7 days after placement to record infection and bleeding scores. Mean infection scores were compared with published historical SPEG data obtained from this institution using the identical scoring system. In 12 cases, a digital force gauge measured peak pull-forces (pounds) required to pull the IOPEG through the abdominal wall and were compared with published SPEG pull-force data. Successful IOPEG placement was achieved in 20/20 (100%). No infectious or bleeding complications occurred. Mean 2 and 7-day infection scores were significantly lower than historical SPEG scores. Mean pull-forces were greater than published SPEG forces. A skin incision is not required for successful PEG placement. Incision omission likely increases PEG pull-forces, but may possibly lead to reduced infection complications.

Abdominal Wall↗