Endoscopy
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Case Reports
Solitary pulmonary metastasis of choroidal malignant melanoma: report of an unusual case.
This brief report describes an unusual case of a patient who had a solitary pulmonary metastasis from an intraocular tumor removed 9 years previously. He was diagnosed by bronchofiberscopy and subjected to right middle lobectomy. Pathological examination revealed that the lesion resulted from direct metastasization to the bronchial wall.
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The recognition of the importance of the enteral route for (hyper) alimentation led us to develop three methods for enteral placement of feeding tubes using endoscopic techniques. With these three treatment modalities it was possible to carry out enteral administration of nutrients in a group of patients, in whom otherwise only total parenteral feeding or enteral feeding by needle catheter jejunostomy was considered feasible. The use of endoscopic equipment permitted correct placement of tubes beyond the stomach either in the duodenum, at the ligament of Treitz or into the jejunum. Also simultaneous distal feeding combined with proximal intestinal drainage in the case of fistula, perforation, anastomotic leakage, or gastric dysfunction was achieved using this endoscopic approach.
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We report 14 patients with tuberculous peritonitis presenting as persistent and exudative ascites. We found a primary site of tuberculous infection in only 10% of the patients. PPD test was positive in 9 patients. ⋯ Four patients had cirrhotic liver disease confirmed by laparoscopy. The biopsy specimen showed caseating granulomata, and the auramine stain was positive in four cases. We conclude that laparoscopy and biopsy is a safe and effective method of obtaining an early diagnosis in patients with tuberculous ascites, especially if they also have cirrhosis.
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Randomized Controlled Trial Clinical Trial
Left-sided colonoscopy in screening programs. What preparation?
In order to limit patients' refusal to undergoing colorectal cancer endoscopic screening procedures, traditional cleansing enemas were compared with a new simpler oral cleansing preparation by means of a randomized controlled trial. Ninety-three patients were evaluated both for compliance and effectiveness of the two modalities tested. No difference in acceptability or effectiveness was detected. The authors discuss more rigorous cleansing techniques routinely used in diagnostic schedules which cannot be considered for preparation for colonoscopy in screening programs.
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Comparative Study
Comparison of standard and large forceps for transbronchial lung biopsy in the diagnosis of lung infiltrates.
In order to determine whether larger biopsy forceps improve the diagnostic yield over smaller standard forceps, we performed 30 transbronchial biopsy procedures in 28 patients with lung infiltrates using three types of instruments. We found that compared to the standard forceps specimens the large forceps acquired larger specimens in 22 of 29 procedures and that the alligator forceps acquired larger specimens in 7 of 10 procedures. ⋯ Four of the patients subsequently underwent open lung biopsy which did not alter the pathologic diagnosis rom the transbronchial biopsy procedure. We conclude that the large forceps do not significantly improve the diagnostic yield of transbronchial biopsy in our patients.