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Timothy A Woodward

Publications and source records attributed to Timothy A Woodward.

17 recordsLinked to original sources
PubMed2007

Accuracy of endoscopic ultrasonography and magnetic resonance cholangiopancreatography for the diagnosis of chronic pancreatitis: a prospective comparison study.

BACKGROUND: The diagnosis of chronic pancreatitis (CP) remains challenging. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) have been proposed as highly accurate diagnostic modalities. Although endoscopic retrograde cholangiopancreatography (ERCP) has been previously used as a gold standard, it is associated with a small but significant risk. We aim to compare the accuracy of EUS and MRCP with the composite gold standard using ERCP, surgical pathology, and/or long-term clinical follow-up. METHODS: Ninety-nine patients with clinical signs and/or symptoms suggestive of CP were prospectively enrolled. The diagnosis of CP by MRCP was established when one or more of these features were present: main duct dilation without obstruction, dilated side branches, intraductal stones, ductal irregularity, reduced T1-signal intensity, parenchymal atrophy, and reduced secretory response to secretin administration. The diagnosis of CP by EUS was made when 4 or more of the established criteria were present. Accuracy of all criteria used ("EUS only," "MRCP only," "either EUS or MRCP," and "both EUS and MRCP") was compared with the composite gold standard. RESULTS: Forty patients were diagnosed with CP by the composite gold standard whereas the remaining 59 patients were controls. EUS only seemed more sensitive but equally specific compared with MRCP only to diagnose CP. The combination of EUS and MRCP had a sensitivity of 98% for either EUS or MRCP and a specificity of 100% for both EUS and MRCP. CONCLUSIONS: EUS and MRCP are highly accurate modalities for the diagnosis of CP and are complementary when used together. If confirmed in larger series, the diagnosis of CP by both EUS and MRCP is highly predictive and ERCP is unlikely to add any useful information.

Adult↗
PubMed2006

Do cytokine concentrations in pancreatic juice predict the presence of pancreatic diseases?

BACKGROUND & AIMS: Cytokine concentration in pancreatic juice of patients with pancreatic disease is unknown. Secretin stimulation allows endoscopic collection of pancreatic juice secreted into the duodenum. We aimed to evaluate the cytokine concentrations in pancreatic juice of patients with abdominal pain to discriminate presence from absence of pancreatic disease. METHODS: From January 2003-December 2004, consecutive patients with abdominal pain compatible with pancreatic origin were enrolled. Patients underwent upper endoscopy. Intravenous secretin (0.2 mug/kg) was given immediately before scope intubation. Pancreatic juice collected from the duodenum was immediately snap-frozen in liquid nitrogen until assays were performed. Pancreatic juice levels of interleukin-8, interleukin-6, intercellular adhesion molecule 1, and transforming growth factor-beta 1 were measured by modified enzyme-linked immunosorbent assays. The final diagnosis was made by the primary gastroenterologist on the basis of medical history; laboratory, endoscopic, and imaging studies; and clinical follow-up. Fisher exact test and Kruskal-Wallis rank sum test were used for statistical analysis. RESULTS: Of 130 patients screened, 118 met the inclusion criteria. Multivariate analysis revealed that only interleukin-8 was able to discriminate between normal pancreas and chronic pancreatitis (P = .011), pancreatic cancer (P = .044), and the presence of pancreatic diseases (P = .007). Individual cytokine concentrations were not significantly different in chronic pancreatitis compared with pancreatic cancer. CONCLUSIONS: Cytokine levels can be measured in pancreatic juice obtained from the duodenum without direct cannulation of the pancreatic duct. Interleukin-8 concentration in pancreatic juice can be used to discriminate between normal pancreas and patients with pancreatic disease. This is a relatively simple and noninvasive method to aid in the diagnosis of pancreatic diseases.

Abdominal Pain↗
PubMed2005

Is zinc concentration in pancreatic fluid a marker for pancreatic diseases?

OBJECTIVES: An imbalance of free radicals and scavenging processes has been implicated in the pathogenesis of pancreatic tissue injury. Gradual decreases in antioxidant enzyme expression in pancreatic cells from normal pancreas to chronic pancreatitis to pancreatic cancer have been reported. Zinc is one of the components of antioxidant enzymes and may play a role in the pathogenesis of pancreatic diseases. A recent report showed a significant decrease in pancreatic zinc output in patients with chronic pancreatitis and proposed that zinc output can be used as an alternative to enzyme output for the diagnosis. We aimed to determine the zinc concentration in pancreatic fluid of patients with chronic pancreatitis and pancreatic cancer compared to normal pancreas. PATIENTS: Seventy-five consecutive patients were prospectively evaluated. Chronic pancreatitis was diagnosed in 20 patients by ERCP (n=16) and histology (n=4). Pancreatic cancer was diagnosed in 17 patients by cytology from EUS-FNA (n=12) or surgical pathology (n=5). Thirty-eight patients were confirmed to have normal pancreas. INTERVENTIONS: Patients underwent esophagogastroduodenoscopy following intravenous secretin injection (0.2 microg/kg). Pancreatic fluid collected for 10 minutes was immediately frozen at -80 degrees C and stored until the assay was performed. MAIN OUTCOME MEASURE: Zinc concentrations were determined by inductively coupled plasma optical emission spectroscopy. RESULTS: Among the three groups, patients with pancreatic cancer were significant older (P<0.001) with a higher prevalence of diabetes mellitus (P=0.002). Gender distribution (P=0.098), body mass index (P=0.925), and history of alcohol use (P=0.997) were similar among groups. Zinc concentrations in pancreatic fluid were not significantly different among groups (P=0.129). CONCLUSIONS: Zinc concentration in pancreatic fluid was comparable in patients with chronic pancreatitis and pancreatic cancer compared to normal pancreas. Zinc concentration in pancreatic fluid collected by our 10-minute endoscopic method cannot reliably be used for the diagnosis of chronic pancreatitis and/or pancreatic cancer.

Acute Disease↗
PubMed2005

Emerging endoscopic techniques in oncology.

New techniques have expanded the role of endoscopy in the diagnosis, staging, therapy, and palliation of malignancies. Three major areas of emerging technologies--endoscopic ultrasound (EUS), luminal stent technology, and photodynamic therapy (PDT)--are discussed in this article. Although EUS and PDT have been used for more than two decades, they have only recently emerged as established integral methods in the armamentarium of the gastrointestinal endoscopist.

Endoscopy↗
PubMed2004

Photodynamic therapy and endoscopic mucosal resection for Barrett's dysplasia and early esophageal adenocarcinoma.

BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic ablation with porfimer sodium photodynamic therapy (PDT) have recently been combined to improve the accuracy of histologic staging and remove superficial carcinomas. MATERIALS AND METHODS: All patients with Barrett's esophagus and high-grade dysplasia were evaluated with computed tomography and endosonography. Patients with nodular or irregular folds underwent EMR followed by PDT. RESULTS: In three patients, endoscopic mucosal resection upstaged the diagnosis to mucosal adenocarcinoma (T1N0M0). PDT successfully ablated the remaining glandular mucosa. Complications were limited to transient chest discomfort and odynophagia. CONCLUSIONS: The use of EMR resection in Barrett's high-grade dysplasia patients with mucosal irregularities resulted in histologic upstaging to mucosal adenocarcinoma, requiring higher laser light doses for PDT. PDT after EMR appears to be safe and effective for the complete elimination of Barrett's mucosal adenocarcinoma. EMR should be strongly considered for Barrett's dysplasia patients being evaluated for endoscopic ablation therapy.

Adenocarcinoma↗
PubMed2003

Resource utilization and procedure parameters for the Stretta procedure: comparison with endoscopic ultrasonography and colonoscopy.

BACKGROUND: No data are available regarding resource utilization of the Stretta procedure and its impact on endoscopy units in comparison with other endoscopy procedures. METHODS: This observational cohort study compared the demographic data and procedural parameters for our first 13 cases undergoing the Stretta procedure, with similar endoscopic colonoscopy and ultrasonography (EUS) cases. RESULTS: The characteristics of the patients were similar among these groups. The patients undergoing the Stretta procedure required significantly more sedative medication than those undergoing colonoscopy or EUS. The Stretta procedure time and recovery time were significantly longer than the colonoscopy procedure time and recovery time. The Stretta procedure time was also significantly longer than the EUS procedure time, but the Stretta recovery time was not significantly longer than the EUS recovery time. CONCLUSIONS: Although this study is small and not randomized, it provides useful information regarding how endoscopic procedures compare with one another. Furthermore, these findings have implications for determining endoscopy unit staffing, work equivalency, and appropriate reimbursement.

Adjuvants, Anesthesia↗
PubMed2003

Whipple's disease with destructive arthritis, abdominal lymphadenopathy, and central nervous system involvement.

We describe a patient with Whipple's disease who had an unusual erosive and destructive polyarthritis, massive abdominal lymphadenopathy, asymptomatic central nervous system involvement, and rare manifestations of orbital pseudotumor and orchitis with epididymitis. Taking oral therapy with trimethoprim-sulfamethoxazole he had recurrent flares of orbital pseudotumor, an episode of orchitis with epididymitis, and persistent polymerase chain reaction T. whipplei-positive cerebrospinal fluid. Resolution was achieved with a one month course of intravenous ceftriaxone and a 6 month course of azithromycin, and no relapse occurred during 24 months of followup.

Abdomen↗
PubMed2002

EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.

BACKGROUND: The liver is a common site of metastases for various malignancies. EUS-guided fine needle aspiration (EUS-FNA) of liver masses has only been reported in small series from single centers. METHODS: A retrospective questionnaire was sent by e-mail to 130 EUS-FNA centers around the world regarding indications, complications, and findings of EUS-FNA of the liver. RESULTS: Twenty-one centers reported 167 cases of EUS-FNA of the liver. A complication was reported in 6 (4%) of 167 cases including the following: death in 1 patient with an occluding biliary stent and biliary sepsis, bleeding (1), fever (2), and pain (2). EUS-FNA diagnosed malignancy in 23 of 26 (89%) cases after nondiagnostic fine needle aspiration under transabdominal US guidance. EUS localized an unrecognized primary tumor in 17 of 33 (52%) cases in which CT had demonstrated only liver metastases. EUS image characteristics were not predictive of malignant versus benign lesions. CONCLUSION: EUS-guided FNA of the liver appears to be a safe procedure with a major complication rate of approximately 1%. EUS-FNA should be considered when a liver lesion is poorly accessible to US-, or CT-guided FNA should be considered when US- or CT-guided FNA fail to make a diagnosis, when a liver lesion(s) is detected (de novo) by EUS, and for investigation of possible upper GI primary tumors in the setting of liver metastases.

Attitude of Health Personnel↗
PubMed2002

Esophageal sarcoidosis: an unusual diagnosis.

We report a 48-year-old patient who developed secondary achalasia because of esophageal sarcoidosis. Sarcoidosis can involve many gastrointestinal tract organs and can affect the esophagus in different ways. We describe how achalasia was diagnosed and treated in our patient and provide a review of the presentations of esophageal sarcoidosis.

Diagnosis, Differential↗
PubMed2002

Photodynamic therapy for dysplastic Barrett esophagus and early esophageal adenocarcinoma.

OBJECTIVE: To evaluate our results using photodynamic therapy (PDT) for the treatment of dysplasia or superficial cancer (T1 N0 M0) in patients with Barrett esophagus. PATIENTS AND METHODS: We retrospectively reviewed our clinical experience with 48 patients (34 patients with high-grade dysplasia and 14 patients with superficial cancer in Barrett esophagus) who had been referred for PDT. Initial evaluation included computed tomography and standard and high-frequency catheter endosonography. Follow-up endoscopy was performed 4 to 6 weeks after PDT with ablation of any residual glandular mucosa, using the argon plasma coagulator. Patients were then followed up indefinitely every 3 to 6 months with computed tomography, endosonography, and endoscopic surveillance. RESULTS: The median series follow-up was 18.5 months (range, 1-56 months). Apparent complete photoablation of Barrett mucosa and/or superficial neoplasm was documented in 47 of 48 cases. Complications included symptomatic strictures (11 patients), photosensitivity (7 patients), atrial fibrillation (1 patient) or recurrent congestive heart failure (1 patient), and self-limited esophageal perforation (1 patient). Failure to ablate T1 N0 M0 adenocarcinoma occurred in 1 patient. CONCLUSIONS: Porfimer sodium PDT appears to eradicate dysplastic Barrett mucosa and neoplasia. These results are promising; however, long-term studies are needed to document the efficacy of PDT in reducing the morbidity and mortality in such patients.

Adenocarcinoma↗
PubMed2002

Large, vascular cecal mass.

A 74-year-old woman had a recent weight loss and history of breast and cutaneous malignancy. Medical evaluation included colonoscopy, which showed a 4 x 3 cm, vascular-appearing mass in the cecum. It was blue-tinged, soft, and easily deformed by pressure. Endoscopic ultrasonography characterized the lesion as a fluid-filled submucosal mass. Because of the suspicion of neoplasm, the patient had exploratory laparotomy and right hemicolectomy. Histopathologic examination revealed a lymphangioma. We review the literature regarding diagnosis and management of colonic lymphangiomas and describe a distinctive case.

Aged↗
PubMedDate not supplied

Selenium concentrations in pancreatic juice of patients with chronic pancreatitis.

BACKGROUND: Free radicals have been implicated as an important mediator in the pathogenesis of tissue injury. Experimental animal models would suggest selenium deficiency contributes to the pathogenesis of chronic pancreatitis (CP). In clinical studies, low plasma selenium levels have been reported in patients with CP. To the best of our knowledge, selenium levels have not been measured in pancreatic juice. METHODS: Twenty-seven patients with chronic intermittent upper quadrant abdominal pain were studied. The diagnosis of CP was made by endoscopic retrograde cholangiopancreatography. Patients were allowed to eat an ad libitum western diet. None of the patients was taking selenium supplements. Patients underwent upper endoscopy with routine conscious sedation. Secretin (0.2 microg/kg) was given i.v. immediately before intubation. Pancreatic juice collected from the duodenum was immediately frozen in liquid nitrogen and stored at -80 degrees C until the assay was performed. Selenium levels of the pancreatic juice were determined using the inductively coupled plasma-mass spectrometry method. RESULTS: Twelve patients had an abnormal pancreatogram. The gender and median age in controls and CP were 11 females and 4 males (54 years, range 32-78) and 7 females and 5 males (56 years, range 37-79), respectively. The etiology of CP was alcohol and idiopathic. The median selenium concentration in controls was 4 microg/mL (range, 2-11.5) and in CP 4.5 microg/mL (range, 2-16). There was not a statistically significant difference between the 2 groups (p = not significant). CONCLUSIONS: The pancreatic juice concentration of selenium is similar in patients with CP compared with age matched controls. Our results would therefore suggest that the effects of selenium on pancreatic injury might be systemic rather than local tissue effect.

Abdominal Pain↗