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PubMed1999

Neuroendoscopic approach to intraventricular lesions.

Object. The purpose of this study was to determine the efficacy of endoscopic treatment in patients with intraventricular tumors. Methods. A series of 30 patients with endoscopically treated intraventricular lesions is reported. The lesions included seven colloid cysts, six astrocytomas, three subependymomas, two ependymomas, and one each of the following: pineoblastoma, pineocytoma/pineoblastoma (intermediate type), epidermoid cyst, pineal cyst, medulloblastoma, arteriovenous hemangioma, cavernoma, choroid plexus papilloma, pituitary adenoma, craniopharyngioma, melanoma, and germinoma. Total tumor resections, partial resections, biopsies, stent implantations, septostomies, and third ventriculostomies were performed. In two cases (two subependymomas > 2 cm in diameter), piecemeal endoscopic resection was ineffective because of the very firm consistency of the tumors. Therefore the endoscopic procedure was discontinued and the tumors were removed microsurgically. In the remaining cases the procedures were completed as planned. Even in the presence of difficulties such as poor orientation or significant bleeding, there was no need to abandon the endoscopic procedure. A total of 28 strictly endoscopic interventions were performed, in which the average duration was 85 minutes (range 35-170 minutes). All colloid cysts and the epidermoid lesion were completely evacuated and the capsules were widely resected. Total extirpation of solid tumors was achieved in five cases, whereas most astrocytomas were partially resected. The hydrocephalus-related symptoms resolved in all of the 22 patients with cerebrospinal fluid pathway obstruction. There were no endoscopy-related deaths. In two cases, major bleeding occurred and was controlled endoscopically. The authors observed one case of meningitis, one of mutism, two of memory loss attributed to forniceal injury, one of transient trochlear palsy after a biopsy specimen of an aqueductal tumor was obtained, and one of transient confusion after a biopsy specimen of a germinoma was obtained. Conclusions. In the authors' preliminary experience, the endoscopic approach was found to be safe and effective. In this series, it was possible to achieve relief of noncommunicating hydrocephalus, tumor resections, and even complete tumor removals by using endoscopic techniques. Based on the results, the authors believe that endoscopic techniques should be considered in the treatment of selected intraventricular lesions.

Journal Article↗
PubMed1980

Metastatic renal cell carcinoma to stomach.

Metastatic tumors to the stomach are distinctly unusual. Rarer still is renal cell carcinoma metastatic to the stomach following radical excision of the primary tumor several years previously. During evaluation for an upper gastrointestinal hemorrhage, a patient was found to have a large antral mass. Endoscopic biopsy revealed renal cell carcinoma. At celiotomy the tumor was found to have penetrated through to the liver capsule. An antrectomy and wedge resection of the left lobe of the liver was performed. There was no evidence of further metastatic disease. This is the first report of such a patient resected for cure, and emphasizes the unique biology of this tumor in its potential for late, solitary metastasis and surgical resectability.

Adenocarcinoma↗
PubMed1986

Treatment of gastric ulcer with enprostil.

This study evaluated the efficacy of two dosage levels of enprostil in 129 patients with gastric ulcer disease. Patients with endoscopically diagnosed gastric ulcer were randomly assigned to receive enprostil 70 micrograms, enprostil 35 micrograms, or a matching placebo capsule twice daily for six weeks. Ulcer healing rates were similar in all treatment groups after two weeks of therapy, but began to show some differences in favor of the enprostil treatment groups after four weeks. Greater differences were noted after six weeks of therapy, with healing rates of 70 percent in the 70-micrograms enprostil group, 82 percent in the 35-micrograms enprostil group, and 50 percent in the placebo group. The six-week healing rate in the 35-micrograms enprostil group was significantly greater than the placebo rate (p = 0.005). Comparison of healing rates in the active treatment groups and the placebo group after six weeks of therapy showed a correlation between therapeutic effect and ulcer size at baseline. This trend is illustrated by a 24 percent difference between the 35-micrograms enprostil group and the placebo group among patients with small (3 to 9 mm) ulcers, compared with a 46 percent difference between these two groups among patients with large (20 to 30 mm) ulcers. Thus, the effectiveness of enprostil is more readily demonstrable in patients with larger ulcers.

Adult↗
PubMed1996

Laparoscopy for Ovarian Endometriomas

Thanks to advances in endoscopic technique and instrumentation, it is possible to remove endometrial cysts by laparoscopy, including total ablation of the cyst capsules. It is difficult to make a clear diagnosis laparoscopically, because some of pathologies have the same appearance (e.g., luteal cysts, follicular cysts). Macroscopically, endometroid cysts are round or elongated. The external surface may be whitish or rust-colored, smooth or covered by adhesions. We analyzed 103 laparoscopic endometrioma resections performed from 1993 to 1995. Laparoscopies consisted of dissection of the ovarian cortex above the cyst, evacuation of cyst contents, cystoscopy, total ablation of its capsule, and bipolar coagulation of its site. Histologically we found endometriosis in 70% of cases, luteal cysts with blood effusion in 20%, follicular cysts in 4%, cysts deprived of epithelial lining in 2%, and serosal cysts in 4%. Unilateral endometriomas were found in 60.9%, and were bilateral in 39.1%. Each patient with a histologically proved diagnosis received danazol 400 to 600 mg/day for 6 to 8 months, and we performed 21 second-look laparoscopies among infertile women after therapy. No adhesion formation was seen. Follow-up was 12 to 14 months after laparoscopy and included vaginal sonography, which showed one (1.28%) recurrence of the ovarian endometrioma.

Journal Article↗
PubMed1990

Effect of enprostil on the gastroduodenal mucosa of healthy volunteers.

Enprostil is a synthetic dehydro-prostaglandin E2 with gastroduodenal ulcer-healing and mucosal-protective properties. One hundred and three healthy volunteers were randomized to receive capsules of enprostil 35 micrograms b.d. (the clinically recommended dose), enprostil 70 micrograms b.d., or placebo b.d. All underwent endoscopic assessment of the gastroduodenal mucosa, scored using a 0-4 scale, at baseline and on Days 3, 7, 14, 21 and 28 of dosing. Mean and median maximum scores demonstrated a dose response, and the mean maximum scores were statistically significantly higher for both enprostil groups on each endoscopy day when compared with placebo. The majority of enprostil-treated subjects had petechial haemorrhages. The proportion of volunteers with small white-based mucosal breaks (erosions) was significantly higher for the fundus in the enprostil 70-microgram group on Days 21 and 28 when compared with placebo, but there were no significant differences between treatment groups for any area on the other study days. The 70-microgram dose was associated with significantly more gastrointestinal adverse events than the 35-microgram dose, which was similar to placebo. There were no significant differences between groups for large white-based mucosal breaks (ulcers). We conclude that oral enprostil produced gastric mucosal petechial haemorrhages, primarily in the fundus of the stomach. Gastric mucosal petechial haemorrhages are probably without clinical significance because they are very common in the general population (10-15%) and do not progress to erosions and ulcers.

Double-Blind Method↗
PubMed2003

Video-assisted submandibular sialadenectomy using an ultrasonic scalpel.

OBJECTIVE: To evaluate the benefits in video-assisted submandibular sialadenectomy by using an ultrasonically activated scalpel (HS: Harmonic Scalpel(R), Ethicon, Somerville, NJ) and a special handmade lifting device. METHODS: The study cohort consisted of four male patients. We considered that the intraglandular part sialolithiasis of the submandibular glands was the main indicator for this technique. Under general anesthesia, a 15-20 mm skin incision was performed just above the inferior margin of the submandibular gland lying parallel to the mandible. We used a 4 mm diameter endoscope that we normally use for paranasal sinus surgery. Appropriate working space was created using a special handmade lifting device that was constructed from a wooden tongue depressor. By using HS, we dissected between the capsule and the circumferential tissue in order to minimize the possibility of damage to the facial nerve and lingual nerve. The submandibular gland was pulled out through the surgical wound, and Wharton's duct was then suture-ligated and resected. RESULTS: Endoscopic operation without recourse to conventional open surgery was achieved in all patients. No patients suffered any complications, such as functional disorder of the marginal mandibular, hypoglossal and lingual nerves, or wound hematoma formation. Excellent cosmesis was obtained in all patients. The amount of intraoperative bleeding ranged from 10 to 60 ml (mean: 38.0 ml). The operating time ranged from 175 to 250 min (mean: 232.5 min). CONCLUSIONS: We applied two useful devices to achieve the endoscopic submandibular surgery: an HS and a special handmade lifting device. Excellent cosmesis was obtained in all patients without complications. The disadvantage of this method is that the surgery is more time-consuming than conventional open methods.

Adult↗
PubMed1995

Prospective study of fluconazole suspension for the treatment of oesophageal candidiasis in patients with AIDS.

BACKGROUND: Oesophageal candidiasis is the most common cause of oesophageal symptoms in patients with AIDS. Antifungal therapy, given as a suspension, may be better tolerated than capsules or tablets in children or patients with oesophageal symptoms. We performed a prospective study of the safety and efficacy of fluconazole suspension. METHODS: Patients with HIV infection; odynophagia, dysphagia, or retrosternal pain; endoscopic evidence of white plaques or exudate in the oesophagus; and microscopic confirmation of fungal infection on biopsy or brushing specimens were eligible. Patients received fluconazole oral suspension (200 mg loading dose followed by 100 mg q.d.s.). Therapy was continued for 2 weeks after symptom resolution. Repeat endoscopy was performed after completion of therapy. RESULTS: Forty-two patients enrolled in the study: 40 were male, mean (+/- s.e.) age was 37 +/- 2 years and mean CD4 cell count was 67 +/- 14/mm3. One patient was not evaluable because he received amphotericin during the first week of therapy. Symptoms resolved in all 41 evaluable patients; 17 (41%) had resolution by 1 week, 37 (90%) by 2 weeks, and 40 (98%) by 3 weeks. Endoscopic resolution occurred in 35 (95%) of 37 patients who underwent repeat endoscopy. Adverse events (skin rash in 1, nausea/vomiting in 2, elevated liver tests in 2) led to early termination of therapy in 5 patients, all of whom had clinical and endoscopic cure. CONCLUSIONS: Symptoms resolved in 100% of patients with AIDS and oesophageal candidiasis receiving an oral suspension of fluconazole, and 90% of patients had symptom resolution within 2 weeks. Determining whether the more rapid clinical cure in this study, compared with a previous trial which employed capsules, is related to an additional topical antifungal effect of the suspension, will require further study.

AIDS-Related Opportunistic Infections↗
PubMed2006

The role of PillCam endoscopy in Crohn's disease: the European experience.

The European experience of wireless capsule endoscopy (WCE) inCrohn's disease (CD) is presented. Evidence from prospectivestudies comparing WCE with standard methods speaks in favor ofWCE as the method with the highest sensitivity for diagnosingsmall intestinal CD. WCE is likely to be helpful in diagnosing CD,in determining the extent of the disease, and in providing infor-mation on which of the current treatment approaches are specifi-cally effective within the small intestine. Although the invention ofthe patency capsule was helpful for diagnosing and characterizingsmall bowel strictures, the problem of capsule retention in CDpatients remains a controversial issue.

Crohn Disease↗
PubMed1977

Controlled trial of Duogastrone in duodenal ulcer.

A double-blind placebo-controlled trial of carbenoxolone, as 50 mg Duogastrone capsules, and in a dose of 200 mg daily for 12 weeks, was carried out in 40 ambulant subjects with endoscopically diganosed duodenal ulceration, of whom 34 were available for final analysis. Each patient was seen every two weeks and endoscoped at four, eight and 12 weeks. Serum carbenoxolone was measured at each visit. Complete ulcer healing occurred in a significantly greater number of patients receiving Duogastrone than placebo, the significance being greater after four and eight weeks treatment (P less than 0-01) than at 12 weeks (P less than 0-02). While significant symptomatic improvement also was achieved (P less than 0-05), but only after 12 weeks on Duogastrone, there was much closer correlation between ulcer healing and symptom relief, 69% on Duogastrone returning to normal, compared with 22% of controls (P less than 0-02). Rise of systolic blood pressure and reduction in serum potassium levels, especially during the last four treatment weeks, were the most common effects noted in patients taking Duogastrone, and five patients required thiazide diuretics and potassium supplements. Higher serum carbenoxolone levels were found in patients with healed ulcers as well as in those with more marked side-effects.

Adult↗
PubMed2003

[Intraductal papillary mucinous tumor: imaging diagnosis].

We describe the specific findings for the diagnosis of cystic pancreatic tumors, serous cystic tumor (SCT), mucinous cystic tumor (MCT), and intraductal papillary-mucinous tumor (IPMT). The typical SCT is easy to diagnose as it is ball shaped and a honeycomb composition is seen on enhanced computed tomography (CT). SCT with large cysts on the periphery, or large cysts which themselves are the major part of the lesion, which we have often seen recently, causes diagnostic problems. The points for diagnosing such a lesion as SCT are 1) ERP does not show communication with the pancreatic duct, and 2) endoscopic ultrasound(EUS) reveals creeping small cysts inside the lesion. While MCT is ball shaped, covered with a relatively thick capsule, and has cysts that are convex into the cavity, IPMT has protruding cavities although it is also ball shaped. Since IPMT basically arises in the large pancreatic ductal system, the diagnosis is easy with by ERP. However, the problem is that histologically IPMT contains invasive cancer and/or hyperplasia, in addition to adenoma and/or adenocarcinoma. For the qualitative diagnosis of IPMT, it is important to measure the height of the tumor protrusions, for which EUS is excellent. Nonetheless, discrimination between adenoma and adenocarcinoma is not easy. Presently, IPMT lesions are differentiated as "adenoma or adenocarcinoma" and "hyperplasia."; Surgery is suggested for the former, and follow-up observation is appropriate for the latter.

Carcinoma, Pancreatic Ductal↗
PubMed2005

Endoscopy in celiac disease.

PURPOSE OF REVIEW: The primary objective of this review is to highlight the evidence for the role of endoscopy in celiac disease. RECENT FINDINGS: Evidence is presented that the endoscopic markers of celiac disease are specific although not sensitive for the disease. Villous atrophy, the hallmark of celiac disease, is patchy in the duodenum, and various techniques may identify areas of villous atrophy. These methods include magnification endoscopy and chromoendoscopy. The most recent innovation, video capsule endoscopy, may be of value in the diagnosis of celiac disease and in the assessment of patients with complicated celiac disease. SUMMARY: Endoscopy and duodenal biopsies are the mainstay for diagnosing celiac disease. Although characteristic endoscopic features may be useful, their absence does not exclude celiac disease. Random biopsy, even of normal-appearing mucosa is necessary for the diagnosis of celiac disease.

Celiac Disease↗
PubMed2005

Validation of low-temperature steam with formaldehyde sterilization for endoscopes, using validation device.

BACKGROUND: Validation of sterilization is an important step before clinical use of medical equipment. Adequate validation of sterilization of the endoscope has not been reported. One reason for this is the lack of suitable devices for validation. METHODS: The VDES (validation device for endoscope sterilization; Olympus prototype model, Olympus, Tokyo, Japan) was designed in two types (type A and type B) and resembles gastroscopes and duodenoscopes, respectively. Each type consists of inner and outer tubing and a central capsule containing a biological indicator. The device was designed to examine the effectiveness of low-temperature sterilizers, such as ethylene oxide gas, hydrogen peroxide gas plasma, and low-temperature steam with formaldehyde (LTSF) sterilizer. The aim of this study was to validate the sterilization of GI endoscopes by the LTSF sterilizer. Sterilization was assessed using both types of VDES after a 60-min application of LTSF. RESULTS: Culture of the biological indicator confirmed the complete eradication of the bacteria in a total of 10 experiments with each type of VDES after LTSF sterilization. CONCLUSIONS: Our results confirm that the LTSF sterilizer may sterilize endoscopes currently distributed by Olympus. Commercialization of VDES will make it possible to evaluate the reliability of sterilization when it is set in the sterilization device with endoscopes.

Bacillaceae↗
PubMed1995

Non-endoscopic method to obtain Helicobacter pylori for culture.

A sampling method to collect samples for Helicobacter pylori culture that is easier than endoscopy would be useful. We used a capsule attached to a highly absorbent nylon string, which is swallowed to obtain gastric secretions. Antral biopsy and string specimens, sequentially obtained from 36 adults with clinically suspected ulcer or gastric disease were cultured. 9 (25%) patients were negative in both tests; 18 (50%) were positive by both methods; 6 (17%) were biopsy positive and string-test negative; and 3 (8%) were biopsy negative and string-test positive. The new test is useful, simple, and causes little discomfort.

Adult↗