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J D Waye

Publications and source records attributed to J D Waye.

179 records · Page 10Linked to original sources
PubMedDate not supplied

Colonoscopic features of colonic anastomoses.

Colonic anastomoses are frequently encountered, but their endoscopic features have never been adequately characterized. Results of 117 consecutive colonoscopies in patients with colonic anastomoses were prospectively studied during a 12-month period. Anastomoses were photographed, videotaped, and reviewed by the authors. The age range of patients was 18 to 87 years, and interval from surgery extended to 42 years. An equal number of right and left colonic resections were encountered; 9 patients had subtotal colectomies. Ninety-two anastomoses were hand-sewn, and 25 were stapled. Ileal pouch-anal anastomoses were not included. Nine common anastomotic features were identified with the following frequency of occurrence: neovascularity, 105 (89.7%); white anastomotic edge, 64 (54.7%); disruption of haustral pattern, 64 (54.7%); radial suture tracks, 35/92 (38.0%); exposed suture, 11/92 (11.9%); exposed staples, 6/25 (24%); scar tissue adjacent to anastomotic line, 8 (6.8%); nondistensibility of anastomosis, 5 (4.3%); blind colonic pouch, 10 (8.5%). No recurrent carcinomas were noted. The site of seven anastomoses (5.5%) could not be identified. Six of these patients underwent endoscopy more than 8 years postoperatively. Of the remaining 110 patients, 94 (85.5%) had between two and four of the above features identified. In three of four patients who required dilation because of strictures, neovascularity was not seen. We conclude that colonic anastomoses have characteristic endoscopic features. These features can be used as landmarks for definitive identification of anastomotic sites at colonoscopy. The lack of neovascularity at a colonic anastomosis may be an indicator of relative ischemia, predisposing to stricture formation.

Adolescent↗
PubMedDate not supplied

Colonoscopy 'my way': preparation, anticoagulants, antibiotics and sedation.

Colonoscopy was introduced in the 1960s. The facility with which this technique is performed has been enhanced by vast improvements in instrumentation. In spite of this, physician attitudes concerning colonoscopy have changed little over the past several decades. The diet for precolonoscopic preparation has not been altered for 30 years. Colonoscopists have a great reluctance to use a new preparation instead of the 4 L electrolyte solution, perhaps because this was such a significant advance in colonoscopic cleansing, its predecessor being castor oil and enemas. Physicians continue to be wary of the patient who is taking acetylsalicylic acid in the absence of any studies that show that this is detrimental for polypectomy. The management of the patient on warfarin anticoagulation remains a subject for debate. As for antibiotic prophylaxis, most endoscopy units do not have a standardized approach, although there are good guidelines that, if followed, should decrease the risk of infective endocarditis. Sedation for the endoscopic examination is usually administered by the colonoscopist, although anesthesiologists may, in some countries (and in some defined areas of the United States) be the primary administrators of sedation and analgesia. The present article is a personal approach to the following issues: the preparation of the colon for an examination, current thoughts about anticoagulation and acetylsalicylic acid, antibiotic prophylaxis for colonoscopy and the technique for sedation out of the hospital.

Analgesia↗
PubMedDate not supplied

The management of patients with colorectal adenomas.

The management of a patient with a colorectal adenoma aims at removal of adenomas that are missed initially or develop subsequently. Classification of adenomas permits the separation of patients into those at minimal and high risk of developing recurrent or new adenomas. Follow-up schedules for these two groups are based on currently available clinical and pathologic data.

Adenoma↗
PubMedDate not supplied

Colonoscopy.

Colonoscopy is an accepted technique for investigation of the colon. No portion of the large bowel is inaccessible to the diagnostic and therapeutic approach by flexible colonoscopy. The technical aspects of instrumentation have yielded to progress, with a small television chip currently incorporated into the tip of endoscopes transmitting an excellent image of the colon. Primary colonoscopy is being performed for selected indications, and, as facility with the technique increases, there will be a greater tendency for the performance of primary colonoscopy. Interruption of the adenoma-carcinoma sequence by techniques of snare-polypectomy may serve to markedly decrease the incidence of colon cancer over the next generation.

Barium Sulfate↗
PubMedDate not supplied

Arterial oxygen desaturation during ambulatory colonoscopy: predictability, incidence, and clinical insignificance.

Arterial hemoglobin oxygen saturation was prospectively monitored in 103 consecutive patients undergoing office colonoscopy to determine the incidence of any clinical characteristics which might predict arterial desaturation to less than 90%. Baseline saturations were obtained prior to premedications and continuously during the examination using a finger mounted pulse oximeter. Intravenous premedication regimens varied from none to a maximal dose of 50 mg of meperidine and 10 mg of diazepam. All colonoscopies included cecal intubation and were performed by one investigator employing a video colonoscope. The incidence of desaturation was 41% without significant variation among the sedation groups. Age was positively correlated with desaturation (p less than 0.05). Sex, obesity, history of lung or heart disease, chronic cardiac medications, and baseline saturation percentage failed to be sensitive predictors of desaturation. No parameter could be correlated with prolongation of desaturation below 90%. No adverse outcomes or complications were noted during the periendoscopy period, suggesting that oximetry monitoring during outpatient colonoscopy may not be clinically useful.

Adult↗