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Biomedical subjects

M F Catalano

Publications and source records attributed to M F Catalano.

46 records · Page 3Linked to original sources
PubMed1991

Cancer of the colon and rectum.

Colorectal cancer remains a significant medical illness and a leading cause of death in the geriatric population. Improvements in management include postoperative surgical adjuvant therapy for colonic cancer and postoperative chemotherapy and radiation for rectal cancer. Some advancement in the diagnostic and screening aspects has occurred. Management decisions in the older patients should follow the same principles as those in the younger age group, although preoperative medical evaluation is especially necessary to evaluate risk and optimize surgical, chemotherapeutic, and palliative outcomes. The best treatment for colon cancer, as for any malignancy, remains prevention. Therefore, additional efforts should focus on developing new and improved screening modalities (especially in the high-risk groups) to identify and remove premalignant lesions as well as to detect early-stage, and therefore potentially curable, large-bowel cancer.

Adenoma↗
PubMedDate not supplied

Preliminary evaluation of the prototype stereoscopic endoscope: precise three-dimensional measurement system.

A prototype stereoscopic endoscope (incorporating two charged-coupled devices), developed for the accurate three-dimensional measurement of gastrointestinal tract lesions, was initially evaluated with two-dimensional target grids and in vitro measurement of 15 objects of known size (marbles, cubes, and rectangular prisms) placed in a plastic model of the sigmoid colon. Images of the objects were captured and stored in a computer. Stereoscopic measurements were compared with results from the standard (open biopsy forceps) method by a blinded endoscopist. The volume measured with the stereoscope did not differ significantly from the true volume, whereas the volume obtained with the open biopsy forceps method differed significantly from the actual volume, consistently underestimating the actual size. The aberration ratios (percentage deviation between the measured and true volume, expressed as mean +/- SD) obtained with the stereoscopic endoscope were superior (9.2% +/- 9.5%) to those obtained with the open biopsy forceps method (-34.0% +/- 26.8%). These preliminary in vitro results with the stereoscope show considerable promise for the simple and precise three-dimensional measurement of gastrointestinal lesions and warrant human clinical trials.

Endoscopes, Gastrointestinal↗
PubMedDate not supplied

How accurate are endoscopic estimates of size?

The accuracy of polyp size estimations in clinical studies is not known. This study was designed to evaluate how well endoscopists can estimate the size of objects at endoscopy. Observations were made by six attending gastroenterologists, six gastroenterology fellows, and seven untrained medical residents. Ball bearings ranging in size from 3 mm to 19 mm were randomly inserted into a latex colon model, and size was estimated while being viewed with a video colonoscope with and without the aid of an open biopsy forceps. Estimated size correlated well to actual size (R ranged from 0.78 to 0.93), although the mean estimates were consistently lower (13% to 29%) than the actual size for all groups, with and without forceps. The use of forceps did not improve the estimates. Exactly correct estimates occurred in 8%; errors of as much as 110% were recorded. The 12 mm bearing was estimated to be less than 10 mm half of the time. We conclude that endoscopists frequently underestimate the size of objects viewed at the time of endoscopy. There was no difference in the performance of experienced gastroenterologists, fellows in training, or untrained residents. This study indicates that better methods of training and for determining size are needed. Research that depends on endoscopic estimates of polyp size may be biased.

Analysis of Variance↗
PubMedDate not supplied

Endosonography in the evaluation of patients with Barrett's esophagus and high-grade dysplasia.

Endosonography, which provides high-resolution images of the esophageal wall, could potentially detect carcinoma not visible endoscopically in patients with Barrett's esophagus and high-grade dysplasia. We studied the ability of endosonography to detect early esophageal carcinoma in 9 patients with Barrett's esophagus and high-grade dysplasia who were candidates for esophagectomy. Pre-operative endoscopy and biopsy revealed high-grade dysplasia without evidence of carcinoma in all patients. Pre-operative endosonographic evaluations were compared to the pathologic diagnoses of resected specimens. Post-operatively, 3 of the 9 patients were found to have intra-mucosal carcinoma. Endosonography identified a tumor in only 1 of these 3 patients and over-staged it as invasive carcinoma (T2, N1). In 2 of the 6 patients without intra-mucosal carcinoma, endosonography predicted invasive carcinoma (T2, N0). Endoscopy revealed mucosal nodularity in each of the 3 over-staged patients. We conclude that recommendation of the routine use of endosonography to determine the need for surgery in patients with Barrett's esophagus and high-grade dysplasia would be premature, because the current generation of echo-endoscopes does not reliably differentiate between benign and malignant wall thickening.

Adenocarcinoma↗
PubMedDate not supplied

Endosonographic features predictive of lymph node metastasis.

Endosonographic features that are thought to characterize lymph node metastasis were evaluated in 100 patients with esophageal carcinoma. Subjects underwent preoperative endoscopic ultrasonography to assess depth of tumor invasion (T stage) and lymph node metastasis (N stage). Endosonographically imaged lymph nodes were evaluated according to the following parameters: size, shape, border demarcation, and central echo pattern. Sensitivity and specificity of endosonography in detecting lymph node metastasis were 89.1% and 91.7%, respectively, when stringent criteria were used. When lymph nodes were imaged endosonographically, regardless of the specific features, the likelihood of N1 disease, was 86%, whereas when no lymph nodes were imaged, the chance of N0 disease was 79%. Endosonographic features predictive of malignancy in increasing order of importance were echo-poor (hypoechoic) structure, sharply demarcated borders, rounded contour, and size greater than 10 mm. Collectively, the EUS features produced an additive effect with respect to accuracy in the prediction of malignant lymph node involvement; malignancy could be predicted with 100% accuracy when all four features were present. These results demonstrate that a careful and systematic approach to the endosonographic assessment of lymph node metastasis can improve staging accuracy.

Aged↗