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3.
Rofo ; 193(7): 804-812, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33535255

RESUMO

PURPOSE: To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon. MATERIALS AND METHODS: 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k). RESULTS: 224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748-0.861). CONCLUSION: Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD. KEY POINTS: · CT has a high sensitivity and specificity for diagnosis of DD.. · CT staging using the CDD algorithm correlates very well with surgery.. · Positive rectal contrast administration does not improve diagnosis and radiological staging.. CITATION FORMAT: · Meyer S, Schmidbauer M, Wacker FK et al. To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804 - 812.


Assuntos
Doenças do Colo/diagnóstico por imagem , Meios de Contraste , Doenças Diverticulares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Doenças do Colo/classificação , Doenças Diverticulares/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Updates Surg ; 70(4): 449-458, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30054817

RESUMO

Duodenal involvement in colonic malignancy is a rare event and poses challenge to surgeons as it may entail major resection in a malnourished patient. Nine patients with malignant colo-duodenal fistula were reviewed retrospectively. Depending on the pattern of duodenal involvement, it was classified as-type I involving lateral duodenal wall less than half circumference; type II involving more than half circumference away from papilla; type III involving more than half circumference close to papilla. Type I was managed with sleeve resection, type II with segmental and type III with pancreaticoduodenectomy. Median age was 47 years, with male to female ratio of 2:1. Eight patients had anemia and seven had hypoproteinemia. Tumor was located in right colon in eight patients and distal transverse colon in one. Diagnosis of fistula was established by CT abdomen in seven (78%), foregut endoscopy in three and intraoperatively in two patients. Two patients had metastatic disease. Elective resection was done in seven while two required emergence surgery. Five patients underwent sleeve resection of the duodenum, two underwent segmental resection and two required pancreaticoduodenectomy. All patients had negative resection margin. One patient died. Median survival was 14 months in eight survivors. Duodenal resection in malignant colo-duodenal fistula should be tailored based on the extent and pattern of duodenal involvement. Negative margin can be achieved even with sleeve resection. En bloc pancreaticoduodenectomy is sometimes required due to extensive involvement. Resection with negative margin can achieve good survival.


Assuntos
Adenocarcinoma/complicações , Doenças do Colo/classificação , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Duodenopatias/classificação , Duodenopatias/cirurgia , Fístula Intestinal/classificação , Fístula Intestinal/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Colectomia , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Neoplasias do Colo/patologia , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Endoscopia Gastrointestinal , Feminino , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Tunis Med ; 94(6): 167-170, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28051217

RESUMO

Background - Crohn's disease is a clinically heterogeneous condition. Our aim was to identify the phenotype evolution of Crohn's disease over time according to the Montreal Classification and to precise predictive factors of the need for immunosuppressant treatment or surgery. Methods - We included Crohn's disease patients who were followed up for at least 5 years. We excluded patients who were lost to follow up before five. Patients were classified according to the Montreal classification for phenotype at diagnosis and five years later. The evolution of phenotype over time and the need for surgery, immunosuppressive or immunomodulatory drugs were evaluated. Results - One hundred twenty consecutive patients were recruited: 70 males and 50 females. At diagnosis, 68% of patients belong to A2 as determined by the Montreal classification. Disease was most often localized in the colon. The disease location in Crohn's disease remains relatively stable over time, with 93.4% of patients showing no change in disease location. Crohn's disease phenotype changed during follow up, with an increase in stricturing and penetrating phenotypes from 6% to 11% after 5 years. The only predictive factor of phenotype change was the small bowel involvement (OR=3.7 [1.2-7.6]). During follow-up, 82% of patients have presented a severe disease as attested by the use of immunosuppressive drugs or surgery. The factors associated with the disease severity were: small bowel involvement (L1), the stricturing (B2) and penetrating (B3) phenotypes and perineal lesions (OR=17.3 [8.4-19.7]; 12 [7.6-17.2]; 3[1.7-8.3] and 2.8 [2.2-5.1] respectively), without association with age, sex or smoking habits. Conclusion - Crohn's disease evolves over time: inflammatory diseases progress to more aggressive stricturing and penetrating phenotypes. The ileal location, the stricturing and penetrating forms and perineal lesions were predictive of surgery and immunosuppressant or immunomodulatory treatment.


Assuntos
Doenças do Colo/patologia , Doença de Crohn/patologia , Fenótipo , Doenças do Colo/classificação , Doenças do Colo/tratamento farmacológico , Doenças do Colo/cirurgia , Constrição Patológica/patologia , Doença de Crohn/classificação , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Feminino , Seguimentos , Humanos , Doenças do Íleo/classificação , Doenças do Íleo/tratamento farmacológico , Doenças do Íleo/patologia , Doenças do Íleo/cirurgia , Íleo , Imunossupressores/uso terapêutico , Masculino , Fatores de Tempo
6.
Dis Colon Rectum ; 58(3): 358-62, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25664716

RESUMO

BACKGROUND: Colonic stenting has failed to show an improvement in mortality rates in comparison with emergency surgery for acute large-bowel obstruction. However, it remains unclear which patients are more likely to benefit from this procedure. OBJECTIVE: The aim of this study is to identify factors that may be predictive of successful outcome of colonic stenting in acute large-bowel obstruction. DESIGN: All patients undergoing colonic stenting for acute large-bowel obstruction between 1999 and 2013 were studied. The demographics and characteristics of the obstructing lesion were analyzed. SETTINGS: This investigation was conducted at a district general hospital. PATIENTS: A total of 126 (76 men; median age, 76 y; range, 42-94 y) with acute large-bowel obstruction were included in the analysis. INTERVENTION: The insertion of a self-expanding metal stent was attempted for each patient to relieve the obstruction. MAIN OUTCOME MEASURES: The primary outcomes measured were technical success in the deployment of the stent, clinical decompression, and perforation rates. RESULTS: Technical deployment of the stent was accomplished in 108 of 126 (86%) patients; however, only 89 (70%) achieved clinical decompression. Successful deployment and clinical decompression was associated with colorectal cancer (p = 0.03), shorter strictures (p = 0.01), and wider angulation distal to the obstruction (p = 0.049). Perforation was associated with longer strictures (p = 0.03). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSION: Colonic stenting in acute large-bowel obstruction is more likely to be successful in shorter, malignant strictures with less angulation distal to the obstruction. Longer benign strictures are less likely to be successful and may be associated with an increased risk of perforation.


Assuntos
Doenças do Colo/complicações , Endoscopia Gastrointestinal , Obstrução Intestinal , Perfuração Intestinal , Intestino Grosso , Complicações Pós-Operatórias/epidemiologia , Stents , Doença Aguda , Idoso , Estudos de Coortes , Doenças do Colo/classificação , Doenças do Colo/patologia , Descompressão Cirúrgica/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/cirurgia , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Intestino Grosso/lesões , Intestino Grosso/patologia , Intestino Grosso/cirurgia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Risco Ajustado , Fatores de Risco , Reino Unido
7.
Mymensingh Med J ; 23(4): 764-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25481598

RESUMO

Bleeding lesion anywhere in the GI tract can cause positive reaction to Immunological Fecal Occult Blood Test (FOBT). Although any colonic lesion can cause occult lower GI bleeding, relative frequency of this lesion not known. Guaic based tests require prior preparation and dietary restriction and less sensitive and specific than IFOBT for detection of occult bleeding .IFOBT is specific for human hemoglobin and is more sensitive and specific for detection of occult bleeding from any colonic lesion. Aim of this study was to diagnose occult gastrointestinal bleeding with positive IFOBT and the prevalence of colorectal disease in IFOBT positive patients in a tertiary care hospital in Bangladesh. This was a prospective cross sectional study conducted in Department of gastroenterology in collaboration with clinical pathology, BSMMU, Dhaka during the period of January 2009 to December 2009. In this study 200 patients meeting the inclusion criteria were included. Detailed clinical history and physical findings were recorded; FOBT was done on single stool specimen. Positive occult bleeding was confirmed in 90 patients of whom 80 patients underwent colonoscopy. The mean age of study population was 36.73±13.64 (range 16 to 72) years. At colonoscopy lesion were identified in 46(57.50%) patients, of which colonic polyp in12 (15%), colorectal cancer in 11(13.7%), inflammatory bowel disease in 3(3.75%), hemorrhoids and anal fissure in 7(8.75%), tuberculosis in 5(6.25%), and proctitis in 1(1.25%) cases. A positive IFOBT is more sensitive and specific test than other FOBT for detection of occult lower GI bleeding of colonic origin. In this study colorectal diseases were detected in 57.50% of the IFOBT positive patients, so IOBT can be used as an important diagnostic tool for detection of occult lower GI bleeding.


Assuntos
Doenças do Colo , Neoplasias Colorretais , Hemorragia Gastrointestinal , Testes Imunológicos/métodos , Sangue Oculto , Adulto , Bangladesh/epidemiologia , Doenças do Colo/classificação , Doenças do Colo/complicações , Doenças do Colo/diagnóstico , Doenças do Colo/epidemiologia , Colonoscopia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Estudos Transversais , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Guaiaco , Humanos , Indicadores e Reagentes , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade
8.
Endoscopy ; 43(10): 882-91, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21818734

RESUMO

An essential element for any new advanced imaging technology is standardization of indications, terminology, categorization of images, and research priorities. In this review, we propose a state-of-the-art classification system for normal and pathological states in gastrointestinal disease using probe-based confocal laser endomicroscopy (pCLE). The Miami classification system is based on a consensus of pCLE users reached during a meeting held in Miami, Florida, in February 2009.


Assuntos
Endoscopia Gastrointestinal , Gastroenteropatias/classificação , Gastroenteropatias/patologia , Microscopia Confocal , Esôfago de Barrett/classificação , Esôfago de Barrett/patologia , Doenças Biliares/classificação , Doenças Biliares/patologia , Doenças do Colo/classificação , Doenças do Colo/patologia , Duodenopatias/classificação , Duodenopatias/patologia , Humanos , Gastropatias/classificação , Gastropatias/patologia
9.
Br J Cancer ; 100(8): 1230-5, 2009 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-19337253

RESUMO

We investigated variations in sensitivity of an immunochemical (I-FOBT) and a guaiac (G-FOBT) faecal occult blood test according to type and location of lesions in an average-risk 50- to 74-year-old population. Screening for colorectal cancer by both non-rehydrated Haemoccult II G-FOBT and Magstream I-FOBT was proposed to a sample of 20 322 subjects. Of the 1615 subjects with at least one positive test, colonoscopy results were available for 1277. A total of 43 invasive cancers and 270 high-risk adenomas were detected. The gain in sensitivity associated with the I-FOBT was calculated using the ratio of sensitivities (RSN) according to type and location of lesions, and amount of bleeding. The gain in sensitivity by using I-FOBT increased from invasive cancers (RSN=1.48 (1.16-4.59)) to high-risk adenomas (RSN=3.32 (2.70-4.07)), and was inversely related to the amount of bleeding. Among cancers, the gain in sensitivity was confined to rectal cancer (RSN=2.09 (1.36-3.20)) and concerned good prognosis cancers, because they involve less bleeding. Among high-risk adenomas, the gain in sensitivity was similar whatever the location. This study suggests that the gain in sensitivity by using an I-FOBT instead of a G-FOBT greatly depends on the location of lesions and the amount of bleeding. Concerning cancer, the gain seems to be confined to rectal cancer.


Assuntos
Doenças do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Fezes/química , Guaiaco , Hemoglobinas/análise , Sangue Oculto , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/patologia , Idoso , Doenças do Colo/classificação , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Feminino , França/epidemiologia , Humanos , Imuno-Histoquímica/métodos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Retais/diagnóstico , Neoplasias Retais/epidemiologia , Sensibilidade e Especificidade
10.
J Law Med Ethics ; 36(2): 320-31, 213, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18547201

RESUMO

Incidental findings (IFs) of potential medical significance are seen in approximately 5-8 percent of asymptomatic subjects and 16 percent of symptomatic subjects participating in large computed tomography (CT) colonography (CTC) studies, with the incidence varying further by CT acquisition technique. While most CTC research programs have a well-defined plan to detect and disclose IFs, such plans are largely communicated only verbally. Written consent documents should also inform subjects of how IFs of potential medical significance will be detected and reported in CTC research studies.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Doenças do Colo/diagnóstico , Colonografia Tomográfica Computadorizada/tendências , Revelação/estatística & dados numéricos , Achados Incidentais , Consentimento Livre e Esclarecido , Sujeitos da Pesquisa , Doenças do Colo/classificação , Feminino , Humanos , Masculino
11.
J Gastroenterol Hepatol ; 21(1 Pt 1): 65-70, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16706814

RESUMO

BACKGROUND: Colonic pseudolipomatosis is rare and the pathogenesis is controversial. The purpose of the present paper was to clarify endoscopic and histological characteristics of colonic pseudolipomatosis and to discuss the etiology. METHODS: A total of 15 lesions from 14 patients was reviewed. They were able to be histologically classified into two groups on the basis of variety in size of the vacuoles: Group A, the ratio of largest vacuole to smallest vacuole in size is less than three, Group B, the ratio is more than four. RESULTS: Four of 15 lesions were group A, and were endoscopically polypoid or flat lesions covered with normal-looking mucosa. They were microscopically characterized by (i) predominant location in the upper portion of the lamina propria; (ii) no submucosal involvement; (iii) less variation in vacuolar size; and (iv) no association with lymph follicles. The vacuoles of group A contained proteinaceous materials in two of four lesions. Group B (11 lesions) had small elevated mucosa with normal-looking surface or non-elevated reddish mucosa. Microscopically, the lesions were mainly located in the lower portion of the lamina propria, occasionally also in the submucosa, had variable-sized vacuoles, and were related to lymph follicles. CONCLUSION: It is suggested that the vacuoles in group A contain fluid, and may indicate an abnormal stagnation of interstitial fluid. Microscopic appearance of group B is essentially similar to that of pneumatosis coli. It is thought that group B probably results from penetration of gas from the crypts into the mucosa during colonoscopy. It is unclear why group B had a preference for ileocecal valve and an association with lymph follicles.


Assuntos
Colo/patologia , Doenças do Colo/patologia , Lipomatose/patologia , Microscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/classificação , Colonoscopia , Feminino , Humanos , Lipomatose/classificação , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Pneumatose Cistoide Intestinal/classificação , Pneumatose Cistoide Intestinal/patologia , Estudos Retrospectivos , Vacúolos/patologia
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 9(3): 214-6, 2006 May.
Artigo em Chinês | MEDLINE | ID: mdl-16721680

RESUMO

OBJECTIVE: To explore the indications for colonoscopy examination and the distribution of diagnostic diseases. METHOD: From Jan. 2000 to Dec. 2004, 5960 patients received colonoscopy examination in our colorectal center. The indications for colonoscopy examination and the distribution of its diagnostic diseases were analyzed. RESULTS: There were 3096 males and 2594 females,and the mean age was (52+/-15) years. The reasons for colonoscopy included hemafecia (26.9%), atypical abdominal pain (25.8%), diarrhea or increased frequency of stool (11.1%), anal tenesmus or discomfort (7.6%), constipation (7.0%),mucous or bloody purulent stool (3.0%), intra-rectal mass or abdominal mass on physical examination (0.9%), re- examination after colonoscopic polypectomy (10.9%), re-examination after operation for colorectal cancer(1.5%), simple health examination (2.2%). Colonoscope reached the cecum in 97.7% of the cases,and at least one disease was found in 2283 cases (40.1%). Among them,colorectal cancer accounted for 10.3%, colorectal polyps 19.6%, ulcerative colitis 4.3%, and Crohn's disease 0.5% respectively. CONCLUSION: The indications for colonoscopy are too strict to screen the early stage colorectal cancer. Colonoscopy should be performed in the cases with symptoms such as bloody stool, diarrhea, abdominal pain, constipation, or with colorectal polyps, after operation for colorectal cancer,or as members of hereditary colorectal cancer family.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doenças do Colo/classificação , Diagnóstico Precoce , Feminino , Humanos , Valva Ileocecal , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Vestn Khir Im I I Grek ; 164(1): 85-9, 2005.
Artigo em Russo | MEDLINE | ID: mdl-15957819

RESUMO

The work was devoted to problems of treatment of patients with cancer of the colon complicated by tumoral colonic obstruction. The authors propose an improved clinical classification of disturbances of colonic obstruction with colorectal cancer. The questions discussed are: decision on the strategy of treatment of acute colonic obstruction patients, the possible differential approach to choosing methods of treatment depending on localization of tumor and duration of the period of the development of intestinal obstruction. The results of treatment of 148 patients with colorectal cancer complicated by acute colonic obstruction are analyzed. It was shown that in 20% of patients with the initial stage of obstruction with the tumor localized in the left half of the colon it was possible to resolve the obstruction by conservative measures followed by the preparation of the patients to planned operation.


Assuntos
Doenças do Colo/etiologia , Doenças do Colo/terapia , Neoplasias Colorretais/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Doenças do Colo/classificação , Doenças do Colo/mortalidade , Doenças do Colo/cirurgia , Colostomia , Feminino , Humanos , Obstrução Intestinal/classificação , Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
14.
Am J Gastroenterol ; 100(5): 1117-20, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15842587

RESUMO

The Crohn's disease activity index (CDAI) is the most widely used measure of clinical disease activity in patients entered into clinical trials. The prospective nature of the CDAI calculation precludes its use as a clinical assessment tool. We compared the retrospective evaluation of the CDAI with the prospective evaluation in a heterogeneous patient population of 100 patients with Crohn's disease. The correlation between the two assessment methods was good with an r-value of 0.84 (p < 0,0001). There was a tendency of patients with a high retrospective CDAI to have a lower prospective CDAI which is explained by intention to treat. This study shows that a retrospective assisted evaluation of the CDAI is as accurate as the traditional prospective evaluation.


Assuntos
Doença de Crohn/classificação , Dor Abdominal/classificação , Antidiarreicos/uso terapêutico , Doenças do Colo/classificação , Doenças do Colo/fisiopatologia , Doença de Crohn/fisiopatologia , Difenoxilato/uso terapêutico , Fezes , Nível de Saúde , Humanos , Doenças do Íleo/classificação , Doenças do Íleo/fisiopatologia , Loperamida/uso terapêutico , Prontuários Médicos , Estudos Prospectivos , Estudos Retrospectivos
15.
Tech Coloproctol ; 8 Suppl 1: s5-6, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15655641

RESUMO

On the matter of the terminology used for large intestine, its sections and different pathologies, a general observation would be that there is a quantity of different sections, words and interchanges that in the end cause some distress in the medical community. The correct terminology assists in the understanding between doctors, some terms, though are standard and unchangeable. Some of those terms are somewhat false but can always be used in a better way. When the relevant knowledge exists, then cooperation between doctors is easier and could help in avoiding mistakes in the future.


Assuntos
Doenças do Colo/classificação , Cirurgia Colorretal/classificação , Terminologia como Assunto , Grécia , Humanos
16.
Biomed Eng Online ; 2: 9, 2003 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-12713670

RESUMO

BACKGROUND: Extracting features from the colonoscopic images is essential for getting the features, which characterizes the properties of the colon. The features are employed in the computer-assisted diagnosis of colonoscopic images to assist the physician in detecting the colon status. METHODS: Endoscopic images contain rich texture and color information. Novel schemes are developed to extract new texture features from the texture spectra in the chromatic and achromatic domains, and color features for a selected region of interest from each color component histogram of the colonoscopic images. These features are reduced in size using Principal Component Analysis (PCA) and are evaluated using Backpropagation Neural Network (BPNN). RESULTS: Features extracted from endoscopic images were tested to classify the colon status as either normal or abnormal. The classification results obtained show the features' capability for classifying the colon's status. The average classification accuracy, which is using hybrid of the texture and color features with PCA (tau = 1%), is 97.72%. It is higher than the average classification accuracy using only texture (96.96%, tau = 1%) or color (90.52%, tau = 1%) features. CONCLUSION: In conclusion, novel methods for extracting new texture- and color-based features from the colonoscopic images to classify the colon status have been proposed. A new approach using PCA in conjunction with BPNN for evaluating the features has also been proposed. The preliminary test results support the feasibility of the proposed method.


Assuntos
Doenças do Colo/classificação , Doenças do Colo/diagnóstico , Colonoscopia/métodos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Modelos Biológicos , Colo/anatomia & histologia , Neoplasias do Colo/diagnóstico , Cor , Diagnóstico Diferencial , Humanos , Redes Neurais de Computação , Reconhecimento Automatizado de Padrão , Propriedades de Superfície
17.
Pediatr Surg Int ; 18(5-6): 361-7, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12415356

RESUMO

In addition to the classified types of dysganglionosis, certain non-classified dysganglionoses (NCD) (types 1-4) were introduced by Meier-Ruge in 1992. Clinical data on these conditions are limited. Among 134 children with intestinal dysganglionoses (ID) treated from 1979 to 1999, 12 were identified to have a NCD. Their clinical course is presented. The existence of mild ID (type 1) is difficult to demonstrate. Current definitions and data on clinical relevance are not convincing. An indication for surgical treatment is not present. Isolated hypogenesis of the submucous plexus (SMP) (type 2, n = 8) is clinically a more severe kind of intestinal neuronal dysplasia type B and often requires early surgical intervention, but not resection. When associated with aganglionosis, its recognition is important for surgical strategy, to avoid complicated clinical courses, which are frequent if total or nearly-total resection is not performed. Hypogenesis of the myenteric plexus (MP) (type 5, n = 1) has received little attention so far. The sporadic appearance of heterotopic nerve cells of the SMP in the mucosa (type 3, n = 1) is physiologic; clusters of such cells, however, are probably of pathologic value, especially in combination with other types of ID in the same patient. Heterotopic nerve cells of the MP (type 4, n = 3) in the circular and longitudinal muscle layers are highly pathologic. This clearly-defined type is of major clinical relevance and requires complete resection. A severe disturbance of the migration process is the underlying cause. To simplify the terminology of IDs, a grading system based on the anatomic structures and clinical findings is proposed: innervation disturbances of the mucosa (grade I) are of limited clinical significance. Isolated malformations of the SMP (grade II) may require an enterostomy, but do not require resection except in certain cases associated with distal aganglionosis. Dysganglionosis of the MP (grade III) usually exhibits more severe symptoms and resection is indicated, especially with associated hypo- or aganglionosis. In aganglionic bowel (grade IV) resection is mandatory.


Assuntos
Doenças do Colo/classificação , Anormalidades do Sistema Digestório/classificação , Gânglios/citologia , Criança , Doenças do Colo/embriologia , Doenças do Colo/patologia , Anormalidades do Sistema Digestório/embriologia , Anormalidades do Sistema Digestório/patologia , Humanos , Plexo Submucoso/citologia
18.
Surgery ; 132(4): 655-61; discussion 661-2, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12407350

RESUMO

BACKGROUND: Restorative proctocolectomy (RP) has been the surgical procedure of choice for surgical management of mucosal ulcerative colitis since 1978. This study was undertaken to investigate the clinical presentation and implications of portal vein thrombi (PVT). METHODS: We reviewed all patients undergoing RP in our institution in the 4 years from January 1997 to December 2000. As the diagnosis of PVT was made on computed tomography (CT) scan in all cases, we confined our incidence estimate to those patients having an abdominal CT scan postoperatively. All scans were reviewed by an experienced radiologist. Patient demographics, symptoms, and clinical course were recorded. RESULTS: A total of 702 patients underwent RP, of whom 94 had a CT scan within the postoperative period. PVT was diagnosed in 42 of the 94 patients (45%). PVT was diagnosed at initial reading of the scan in 11 patients, and on review in 31. The indications for CT scan included abdominal pain, fever, leukocytosis, and delayed bowel function. Septic complications of RP caused these symptoms and signs in 45 patients, 20 of whom had PVT. Twenty-two patients were found to have had PVT without evidence of any septic source. CONCLUSION: PVT can be found in a high proportion of patients undergoing abdominal CT scan after RP. It is often associated with pain, fever, nausea vomiting, tenderness, and leukocytosis. This study shows that PVT subtle enough to go undiagnosed has no serious consequences, even when not treated. Also, patients treated with anticoagulation recover completely.


Assuntos
Veia Porta , Proctocolectomia Restauradora/efeitos adversos , Trombose Venosa/etiologia , Adulto , Estudos de Coortes , Doenças do Colo/classificação , Doenças do Colo/cirurgia , Neoplasias do Colo/cirurgia , Doença de Crohn/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
19.
Ann Ital Chir ; 73(1): 47-57, 2002.
Artigo em Italiano | MEDLINE | ID: mdl-12148422

RESUMO

The authors, referring to their experience, make a review of colic pathological features presenting as right abdominal mass. Despite of modern diagnostic means--specially radiological investigations: ultrasonographic and CT scanning--accurate clinical examination still plays a role in the initial assessment and to address diagnostic procedures. Diagnosis may be difficult as the right colon is hardly accessible even to present investigative means. US scanning has proved to be useful, in the surgeon's hands, for timely detection of the lesion and in monitoring its evolution. Many diseases must be considered in the diagnosis of a right colon mass and a few rare too: Meckel diverticolitis, carcinoid, vermiform appendix pseudomyxoma, amebic granuloma, Kaposi's sarcoma. Treatment is still an intriguing question, depending on many factors: site, kind and variety of the diseases showing as right abdomen mass, difficulty in early diagnosis, risk of misdiagnosing, shortage of series reported in literature and the absence of multicenter studies.


Assuntos
Doenças do Colo/diagnóstico , Doenças do Colo/cirurgia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/classificação , Doenças do Colo/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Ultrassonografia
20.
J Vasc Surg ; 34(6): 986-96, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11743550

RESUMO

OBJECTIVE: The purpose of this study was to analyze the incidence, severity, and etiologic factors of the development of colon ischemia after endovascular aortoiliac aneurysm repair (EVAR). METHODS: During the last 9 years we performed 278 elective EVARs using a variety of grafts. To facilitate these repairs, one hypogastric artery (HA) was coil embolized in 109 patients and both HAs were coil embolized in 13 patients. The preprocedural status of the inferior mesenteric, hypogastric, and iliac arteries as well as anatomical characteristics of the abdominal aortic aneurysm were determined arteriographically and by computerized tomographic scans. Postoperative colon ischemia was documented by colonoscopy or operative findings. RESULTS: Colon ischemia occurred in eight patients (2.9%). Three patients with colon ischemia died and had evidence of widespread (cutaneous, renal, small bowel, and/or lower extremity) microembolization. One of these three had a colectomy and microscopic emboli were present. One other patient who required a colectomy also had pathologic evidence of colonic microembolization but survived. Four other patients with colon ischemia were treated conservatively and survived. In one patient, previous colectomy with interruption of mesenteric collaterals may have been a contributory cause of colon ischemia. Of the eight patients with colon ischemia, only one had unilateral HA occlusion, and none had bilateral HA occlusion. The other 121 patients with unilateral and bilateral HA occlusion had no evidence of colon ischemia. CONCLUSIONS: Colon ischemia occurs after EVAR with an incidence approximating that of open repair. Colon ischemia was unrelated to HA interruption. Embolization appears to be a major cause of colon ischemia, although inadequate mesenteric collateral circulation may also play an etiologic role. Mortality with colon ischemia accompanied by widespread embolization was high, whereas colon ischemia without it was often mild and amenable to nonoperative management.


Assuntos
Angioplastia/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Doenças do Colo/etiologia , Embolia/etiologia , Aneurisma Ilíaco/cirurgia , Isquemia/etiologia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Angioplastia/instrumentação , Angioplastia/métodos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Colectomia , Doenças do Colo/classificação , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/epidemiologia , Doenças do Colo/terapia , Colonoscopia , Embolia/diagnóstico , Embolia/epidemiologia , Embolia/terapia , Embolização Terapêutica/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca , Incidência , Isquemia/diagnóstico , Isquemia/epidemiologia , Isquemia/terapia , Pessoa de Meia-Idade , Politetrafluoretileno , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Stents , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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