Biomedical subjects

T Saifuddin

Publications and source records attributed to T Saifuddin.

5 recordsLinked to original sources

PubMed2000

Usefulness of a pediatric colonoscope for colonoscopy in adults.

BACKGROUND: There are few published data on how different types of colonoscopes affect success in reaching the cecum and patient comfort. We examined the feasibility of using a pediatric colonoscope for routine colonoscopy in adults and investigated whether there were subgroups of patients in whom use of this instrument was preferable. METHODS: One-hundred fifty adults undergoing outpatient colonoscopy were randomized to colonoscopy with a standard colonoscope (Olympus CF-100L) or with a pediatric colonoscope (Olympus PCF-100). All procedures were performed by a faculty endoscopist and timed by an independent observer. After examinations, the endoscopist graded procedure difficulty and patients were given a questionnaire that assessed their experience. RESULTS: The adult (n = 77) and pediatric (n = 73) colonoscope groups were comparable in all outcomes measured, including success in reaching the cecum (91% vs. 93%, p = 0.61), mean time to reach the cecum (11.4 vs. 9.7 min, p = 0.07), mean total procedure time (21.8 vs. 21.9 min, p = 0.95), mean meperidine dose (55 vs. 52 mg, p = 0.17); median midazolam dose (2.0 mg in both groups, p = 0.10), the endoscopists' perception of procedure difficulty, and patient comfort scales. Of the 7 patients in whom colonoscopy with the adult colonoscope was unsuccessful, the cecum was reached in 4 by switching to a pediatric colonoscope (all women, 3 of whom had prior hysterectomy). In the 5 patients in whom colonoscopy with the pediatric colonoscope was unsuccessful, the cecum was reached in 1 by switching to an adult colonoscope. Including the cases in which the cecum was reached by switching to the alternative colonoscope, the overall frequency of cecal intubation was 143 of 150 (95%). Subgroup analysis disclosed no difference between the 2 groups in outcomes when gender, presence of diverticulosis, and patient size were considered. Colonoscopy with the pediatric colonoscope was more successful than with the adult instrument in reaching the cecum in women with prior hysterectomy (11 of 12 [92%] vs. 15 of 21 [71%]); however, the numbers in each group were relatively small and the difference was not significant (p = 0.22). CONCLUSIONS: The pediatric colonoscope is suitable for routine colonoscopy in adults. It is also useful in patients in whom colonoscopy with the adult colonoscope is unsuccessful in reaching the cecum (particularly in women). Additional study is needed to see if the pediatric colonoscope is actually superior to the adult colonoscopy for routine colonoscopy in women with prior hysterectomy.

Adult↗

PubMed1999

Duodenal somatostatinoma presenting as upper gastrointestinal bleeding.

Duodenal somatostatinoma is a rare cause of upper gastrointestinal bleeding. We report the case of a 55-yr-old woman who presented with upper gastrointestinal hemorrhage due to a duodenal somatostatinoma. We discuss the characteristics of these tumors, and review the literature on diagnostic workup and management.

Duodenal Neoplasms↗

PubMed1999

Patient attitudes toward undergoing colonoscopy without sedation.

OBJECTIVE: The vast majority of patients undergoing colonoscopy in the United States are given sedation. There are a number of potential advantages to performing colonoscopy without sedation. We sought to determine the attitude of patients toward unsedated colonoscopy in our three practice settings (a university medical center, a cancer center, and a Veterans Affairs medical center), and to see if there were factors that predicted willingness to try it. METHODS: Four-hundred thirty-four adult patients undergoing outpatient colonoscopy completed questionnaires before and after their procedures providing demographic information and assessing willingness to undergo colonoscopy without sedation. Patients were routinely given meperidine and midazolam for their procedures unless they specifically requested that they be unsedated (10 patients). RESULTS: Only 16.9% of our patients were willing to undergo colonoscopy on their preprocedure questionnaire. Willingness increased modestly on the postprocedure questionnaire to 22.6% (p = 0.01). Logistic regression analysis disclosed that male gender, having a college degree, low anxiety based on preprocedure anxiety scales, and lower doses of sedative drugs used during colonoscopy were the best predictors of willingness to undergo colonoscopy without sedation in the future. CONCLUSIONS: Only about a fifth of patients undergoing colonoscopy in our three practice settings expressed a willingness to try colonoscopy unsedated. Male gender, higher levels of education, and low anxiety scores on simple scales of preprocedure anxiety may help to predict willingness. Efforts to substantially increase the frequency of patients willing to undergo colonoscopy without sedation will likely require increased patient counseling and education.

Adult↗

PubMed1999

Intrasphincteric botulinum toxin type A for the diagnosis of sphincter of Oddi dysfunction: a case report.

Biliary-type pain from sphincter of Oddi dysfunction is not uncommon after cholecystectomy. An increased basal pressure of sphincter of Oddi manometry establishes the diagnosis and treatment is usually by endoscopic sphincterotomy. Both procedures carry a significant complication rate. A few patients with elevated sphincter pressure do not respond to therapy; the source of their pain may be elsewhere. This case report describes the use of intrasphincteric botulinum toxin injection for the diagnosis of sphincter of Oddi dysfunction in a patient after repeated attempts at manometry had failed. This may provide a safe and easy method of determining whether sphincter of Oddi dysfunction may be the cause of biliary pain in post/ cholecystectomy patients and help select patients who would benefit from subsequent sphincter ablation, without the risks of sphincter of Oddi manometry. Prospective studies are first needed.

Adult↗

PubMed1998

Colonoscope flexural rigidity measurement.

A testing device is developed that determines the stiffness, or flexural rigidity, of an endoscope at specific locations down its length by subjecting it to a compressive axial force, a situation similar to the actual forces applied to the endoscope during a clinical procedure. The endoscope is made to deform in a similar fashion to a slender buckled column and the force causing this deformation is related to the flexural rigidity using column buckling theory. A direct relationship between the critical load needed to cause buckling and the square of column length L is demonstrated experimentally and is expected theoretically, giving confidence in the application of column buckling theory to endoscope testing. Additional confidence in the validity of the column buckling test results is obtained by their similarity to data obtained by subjecting the endoscope to a transverse load, determining deflection, and modelling the endoscope as a bent elastic beam. Several makes and models of endoscopes were tested, with flexural rigidity values typically ranging between 160 to 240 Ncm2. The effect of a metal stiffener inserted in an endoscope's accessory channel is quantified, as is the change in flexural rigidity down the insertion shaft of a graded-stiffness endoscope. Significant differences in flexural rigidity were obtained between identical endoscopes, each sharing similar usage histories, indicating the need for flexural rigidity measurements for each individual endoscope of a particular model line, though a more extensive study is required to reliably determine scope-to-scope stiffness variations for a particular model line.

Colonoscopes↗