A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions.

BACKGROUND: Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA. METHODS: Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE). RESULTS: A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention. CONCLUSIONS: Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.

Analog image recording using a laser printer and paper system.

This article describes a method for generating gray scale analog hard copy images on ordinary paper using a laser printer system. Operation of the computer-controlled laser printer is described. The cost of the laser printer/paper technology is estimated and compared with the cost of multiformat camera/conventional film systems. Results of an initial clinical evaluation of laser printed paper images are presented.

Estimating digital information throughput rates for radiology networks. A model.

The design and implementation of a digital radiology image management system requires the definition, evaluation, and comparison of appropriate measures of system performance. The mean throughput rate is an important measure of the actual performance of a finished system. The mean throughput rate identifies the transmission of digital information either in bits/second or tasks/second. It is dependent on software, database management, equipment interface designs, number of users and display stations, and communications media. The mean throughput rate can document resource allocation bottlenecks within a given system. A model for estimating the mean throughput rate and its application in helping us design our radiology digital image networks is described.

A practical approach to the diagnosis of abdominal aortic aneurysms.

In this study 217 patients with proved abdominal aortic aneurysm were reviewed and the diagnostic accuracy of ultrasonography was assessed in comparison with physical examination, plain abdominal roentgenography, and aortography for the evaluation of patients with a suspected abdominal aortic aneurysm. Ultrasonography is most accurate in detecting an aneurysm and in defining the size of the aneurysm. Routine aortography to evaluate the renal and iliac artery is not justified in the preoperative evaluation of patients with an abdominal aneurysm since the renal artery infrequently is involved by the aneurysmal process (3.7 percent) and the surgical results are consistently successful in those patients with renal and/or iliac artery involvement. If preoperatively needed, the renal status can be evaluated accurately with an isotope renogram combined with photoscan of the kidney. A practical approach to the diagnosis of pulsatile abdominal masses is proposed.

Digital image management: networking, display, and archiving.

The requirements for implementing a radiology imaging network are similar to those for local area networks now being designed for other purposes to manage large data films. A radiology department serving a 500-bed hospital generates about 927 megabytes of digitally formatted data per working day. These data are expected to be on line for the patient's hospitalization period. The retrieval rate of these data among the interactive diagnosis display stations requires data throughput rates of between 2 and 5 megabits per second. This throughput rate requires signaling rates of between 20 and 50 megabits per second. Analog hard-copy generation of the images on the network is required by the referring physician for selected images that support the consultation report. Digital laser recorders using paper may be quite satisfactory. Long-term archiving must be low in cost and requires a database scheme capable of managing more than a terabyte of image data. Radiology networks must be required to bridge with other hospital information systems.

Peripheral enhancement in computerized cranial tomography: a non-specific finding.

Peripheral enhancement of intracranial lesions on CT examination is still being considered by some radiologists as specific for an abscess or a cystic tumor. A review of the last 4,000 scans at this institution has demonstrated that it is neither specific nor, in many cases, of much help in the differential diagnosis of the lesions. Examples of the various types of lesions that can demonstrate peripheral enhancement are shown. It is suggested that many if not all types of pathology would demonstrate this effect if the cranial CT scans were done at a fortuitous time or sequentially. Some differential diagnostic suggestions are also made.

The ultrasonic demonstration of inferior vena caval compression: a guide to pancreatic head enlargement with emphasis on neoplasm.

The ultrasonic demonstration of compression of the anterior (ventral) wall of the inferior vena cava by the pancreatic head was proved to be a reliable sign of neoplasm enlarging the pancreatic head in 10 patients. It would appear that this sign is less reliable and probably not as important diagnostically in patients with pancreatic head enlargement secondary to pancreatitis or pseudocyst. This sign must be constant and reproducible on longitudinal scans done with a single transducer pass in suspended inspiration. This sign was not seen in 50 patients who had no evidence of pancreatic disease.

Digital image management: networking, display, and archiving.

The requirements for implementing a radiology imaging network are similar to those for local area networks now being designed for other purposes to manage large data films. A radiology department serving a 500-bed hospital generates about 927 megabytes of digitally formatted data per working day. These data are expected to be on line for the patient's hospitalization period. The retrieval rate of these data among the interactive diagnosis display stations requires data throughput rates of between 2 and 5 megabits per second. This throughput rate requires signaling rates of between 20 and 50 megabits per second. Analog hard-copy generation of the images on the network is required by the referring physician for selected images that support the consultation report. Digital laser recorders using paper may be quite satisfactory. Long-term archiving must be low in cost and requires a database scheme capable of managing more than a terabyte of image data. Radiology networks must be required to bridge with other hospital information systems.

Computer networks for image management in radiology: an overview.

Currently, images obtained from digital radiographic modalities are archived and managed as analog images recorded on radiographic film. An alternative for total image management is a computer-based digital network. General design considerations for a digital image network are reviewed, and estimates of important system parameters are determined.

B-scan ultrasound evaluation of the pancreas. Advantages and accuracy compared to other diagnostic techniques.

Over 200 patients were examined by B-scan ultrasound for suspected pancreatic disease; in 94 cases a final diagnosis was proved. The diagnostic accuracy of ultrasound, upper gastrointestinal examination, isotope pancreatography, and arteriography is compared. The diagnostic ultrasound features of the various pancreatic disease processes are described. Pancreatic sonography provides the most accurate and least expensive method for evaluating the pancreas with no known patient morbidity. The upper gastrointestinal series and radionuclide study are complementary to sonography. Ultrasound should be the initial examination for the evaluation of patients with suspected pancreatic disease or epigastric mass.

Preoperative diagnosis of potentially precancerous breast lesions by computed tomography breast scanner: preliminary study.

Eighteen cases of severe atypical epithelial hyperplasia of the breast were detected preoperatively by computed tomography breast scanner (CT/M) with contrast enhancement. The CT number before enhancement ranged from -17 to +31 and increased to 26 to 42 after enhancement (5.2-8.4% increase in attentuation). These data suggest that CT/M can differentiate these potentially precancerous lesions from benign fibrocystic disease.