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Biomedical subjects

N Soehendra

Publications and source records attributed to N Soehendra.

At least 109 records · Page 6Linked to original sources
PubMed1994

Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes.

The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has made fine-needle aspiration biopsy (FNAB) under direct endosonographic guidance possible. Because the imaging and instrumentation planes overlap, the operator can visualize a biopsy needle lengthwise as it enters the sector-shaped sound field. We performed EUS-guided FNAB of lymph nodes in seven patients who met the following criteria: (1) Lymph node size over > 1 cm; (2) no endoscopic or endosonographic evidence for tumor involvement of bowel wall interposed between the lymph node and the transducer; and (3) absence of coagulopathy or thrombocytopenia. A positive tissue yield was obtained in six patients, of whom five had malignant cells identified on cytology. The patient with an inadequate yield had a dry aspirate, possibly related to prior irradiation treatment for esophageal carcinoma. No procedure-related complications were observed. We conclude that EUS-guided FNAB of lymph nodes is technically feasible, provides a high diagnostic yield, and appears to be safe. Further studies to determine the sensitivity and specificity of this novel procedure are warranted.

Adult↗
PubMed1994

Pulverisation of calcified and non-calcified gall bladder stones: extracorporeal shock wave lithotripsy used alone.

Using a modified electromagnetic lithotripter (Siemens), extracorporeal shock wave lithotripsy (ESWL) was performed in 260 patients with gall bladder stones. Exclusion criteria for treatment were a non-functioning gall bladder, subcostal gall bladder location, and multiple stones occupying more than three quarters of the gall bladder volume. Stone pulverisation was the end point of ESWL. The number of shock wave discharges and sessions was not limited. Pulverisation was achieved in 250 patients (96.1%) after a median of three ESWL sessions (range 1-21). The number of sessions required depended upon stone composition and burden. More than three sessions were required in 60.2% of patients with calcified stones compared with 35.9% of patients with non-calcified stones (p < 0.001). 65.8% of patients with stones measuring more than 30 mm in total diameter required more than three sessions compared with 42.9% of patients with a stone burden less than 30 mm (p < 0.01). At 18-24 (8-12) months follow up, stone clearance was achieved in 94.3% (80.4%) of patients with non-calcified stones, compared with 89.5% (76.8%) in patients with calcified stones and in 75% (71.4%) of patients with a total stone diameter more than 30 mm compared with 95.7% (80.4%) for patients with a total stone diameter less than 30 mm (p < 0.05). ESWL related complications (gross haematuria) occurred in three patients. Thirty six (13.8%) patients experienced biliary colic; four had cholecystectomy, and five endoscopic papillotomy because of common bile duct obstruction. Stone recurrence was seen in 5.3% of patients over a follow up period of up to two years (median 16.6 months).

Adolescent↗
PubMed1994

[Endoscopic techniques in therapy of choledocholithiasis].

Endoscopically, approximately 85% of all bile duct stones can be removed immediately after successful papillotomy. For the remaining cases, complete clearance of the bile duct is achieved by lithotripsy techniques. Due to the lower risks, endoscopic treatment is preferable.

Cholecystectomy, Laparoscopic↗
PubMed1993

Endoscopic hemoclip treatment for gastrointestinal bleeding.

We conducted an uncontrolled study to evaluate an improved metallic clip (Olympus hemoclip) for the endoscopic treatment of nonvariceal gastrointestinal bleeding. A total of 88 patients (mean age 63 +/- 14, 60 males) with bleeding from a wide range of sources were treated. Seventy-eight patients had active bleeding (spurting in 50, oozing in 28) and 10 patients had a nonbleeding visible vessel. Initial hemostasis was achieved in all patients with active bleeding. A total of 255 clips were placed (average of 2.9 clips per patient, range of 1-10 clips). Spurting arterial bleeders required more clips on average than oozing bleeders (3.2 versus 2.7); active bleeders required more clips than cases with nonbleeding visible vessels (3.0 versus 2.2). Mean follow-up was 397 +/- 148 days. Recurrent bleeding was observed in 5 patients, all of whom had active bleeding on initial presentation. Re-bleeding was successfully treated with hemoclips in 4 patients and one patient underwent surgery. Clips appeared to be retained well; early clip dislodgement resulted in rebleeding in only 1 patient. No complications resulted from this treatment. Clips did not impair healing of peptic ulcers. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating nonvariceal gastrointestinal bleeding and deserves comparative studies with other methods of endoscopic hemostasis.

Evaluation Studies as Topic↗
PubMed1993

"Endoscopy friendly" resection technique of choledochal cysts.

The resection of a choledochal cyst was performed in two patients (22 and 31 years old, both type Todani IVa). Reconstruction of the biliary-intestinal drainage was performed by interposition of a 15 cm jejunal segment between the liver hilum and duodenum. In both patients, hepatico-jejunostomy could be endoscopically evaluated 5-6 months after the operation, showing patent anastomoses without any signs of reflux or cholangitis.

Adult↗
PubMed1993

Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy.

Over a 34-month period (1989-1991), 791 patients were diagnosed at endoscopic retrograde cholangiography to have bile duct stones. All patients underwent sphincterotomy and attempted extraction by Dormia basket. This was successful in 683 patients (86%). The remaining 108 patients with "difficult stones" (mean age 72 years) underwent mechanical, electrohydraulic or extracorporeal shock wave lithotripsy according to the following algorithm: (1) Mechanical lithotripsy for stones which could not be extracted after entrapment in the Dormia basket (n = 33); (2) peroral cholangioscopic electrohydraulic lithotripsy for stones which could not be engaged in the Dormia basket (n = 65); or (3) extracorporeal shock wave lithotripsy for intrahepatic stones (n = 10). Stone fragmentation and clearance was successful in all patients treated by mechanical lithotripsy, was unsuccessful in one patient submitted to electrohydraulic lithotripsy due to inability to insert the cholangioscope into the bile duct and failed in 3 patients treated by extracorporeal shock wave lithotripsy. Overall, 95% of difficult bile duct stones refractory to conventional endoscopic basket extraction were removed using the above lithotripsy techniques. There were no serious procedure-related complications.

Aged↗
PubMed1993

Endosonography for preoperative locoregional staging of esophageal and gastric cancer.

To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal and gastric carcinoma, we performed a prospective controlled study over a five year period. Data from 63 patients with esophageal cancer and 147 patients with gastric cancer who underwent surgery were available for comparison of the endosonographic TNM classification to the histophathological findings of the resected specimens. The overall accuracy of EUS in the assessment of tumor infiltration depth was 85.7% and 78% in esophageal and gastric cancer, respectively. The sensitivity of EUS in the detection of regional lymph node metastases was 90% in esophageal and 87% in gastric carcinoma. The most frequent causes of misdiagnoses by endosonography were microscopic tumor invasion and peritumorous inflammatory changes. The inability to traverse a tumor stenosis restricted the endosonographic evaluation in 31.6 and 14% of the cases with esophageal and gastric cancer, respectively.

Endoscopy, Gastrointestinal↗
PubMed1993

[Diffuse pseudo-diverticulosis of the esophagus with severe cranial stricture, axial hiatal hernia and Barrett syndrome].

We report about a patient with esophageal intramural pseudodiverticulosis (EIP) who was referred to our department for further investigation of dysphagia. EIP is a rare, pathologically well defined disease, most frequently characterized by stricture-associated symptoms. The diagnosis of EIP is made by barium swallow and can be confirmed by endoscopy which shows typical diverticula-like changes of the esophageal wall.

Aged↗
PubMed1992

Enlarged lymph nodes: malignant or not?

Prospective controlled data of lymph node evaluation by endoscopic ultrasound in esophageal, gastric and pancreatic cancer is presented. Lymph node pattern, changes of boundaries and echogenicity were considered. Preoperative findings of endoscopic ultrasound were classified according to TNM staging. Only those cases with subsequent histologic examination of the resected specimen were entered into the study. Sensitivity of endoscopic ultrasonography (EUS) was 90% for esophageal and 87% for gastric cancer. The specificity was 72% and 88%, respectively. In spite of the overall satisfactory results of EUS in evaluation of lymph nodes, further improvement in detection and differentiation of benign and malignant nodes is required.

Endoscopy, Digestive System↗
PubMed1991

Endoscopic sclerotherapy--personal experience.

Over the last 12 years, treatment of bleeding esophageal and gastric varices has improved considerably. By the use of new techniques and with increased experience the results of endoscopic sclerotherapy have been optimized. Acute variceal bleeding, esophageal or gastric, can now be reliably and definitively stopped using the tissue adhesive Histoacryl Blau. This is also applicable to all patients irrespective of their liver status at presentation. As expected, the mortality of acute variceal bleeders has decreased considerably, no death from bleeding occurring in the last 5 years. This has obviated the need for emergency surgery, balloon tamponade or vasopressin infusion. Using an aggressive sclerotherapy technique in the bleeding-free interval, varices of all grades can now be effectively eliminated within an average of 3 sessions covering 3-4 weeks. With the intra- cum peri-variceal injection technique not only are the visible veins eradicated, but also fibrosis of the inner esophageal wall is achieved at the same time. If careful attention is paid to certain details of the technique and instruments, and with close follow-up, patients of portal hypertension can now live well in terms of liver function, without the danger of further variceal bleeding.

Endoscopy, Gastrointestinal↗