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Biomedical subjects

T H Baron

Publications and source records attributed to T H Baron.

At least 19 recordsLinked to original sources
PubMed2001

Improved diagnostic yield of endoscopic biliary brush cytology by digital image analysis.

OBJECTIVE: To evaluate the accuracy of digital image analysis (DIA) for distinguishing between benign and malignant strictures of the biliary tract. PATIENTS AND METHODS: Our pathology databank was used to identify all biliary brush cytology specimens obtained during endoscopic retrograde cholangiopancreatography between June 1997 and June 1999. Corresponding medical records were reviewed to determine whether patients had benign or malignant strictures. Strictures were further classified into benign strictures with negative routine cytology, malignant strictures with negative routine cytology, and malignant strictures with positive routine cytology. Papanicolaou-stained smears of available brush cytology specimens were destained and then restained with Feulgen dye. Nuclear images were quantified for DNA content without knowledge of stricture type. DNA histograms were generated and ploidy results compared with the class of stricture. RESULTS: We analyzed 27 specimens from 69 confirmed benign or malignant strictures. Assuming that the presence of any aneuploid cells indicated malignancy, the sensitivity of DIA was 85%. Furthermore, aneuploid cells were detected by DIA in 13 of 16 specimens in which routine cytology was unrevealing. CONCLUSION: Ploidy assessment by DIA has potential to enhance the sensitivity of diagnosing malignant strictures compared with routine cytology alone.

Adult↗
PubMed2000

Stents and lasers for colonoscopic lesions.

The use of self-expanding metal stents (SEMS) in the colon is now becoming more commonplace. These devices can be employed to decompress large bowel that has become obstructed from either benign or malignant disease. Many studies in the past year have validated the use of colonic SEMS to allow preoperative bowel preparation in resectable patients, or as an alternative to surgery in those requiring palliative therapy alone. Laser therapy has also gained new ground in recent months because it has been shown to help in recanulation of obstructed bowel to aid in SEMS placement. In addition, laser therapy alone can be used to treat some colonic lesions that had formerly been treated surgically.

Colorectal Neoplasms↗
PubMed2000

Endoscopic removal of an embedded biliary Wallstent by piecemeal extraction.

Expandable metal biliary stents are reserved for patients with unresectable malignant biliary obstruction. Occasionally, these stents may cause complications necessitating removal. We describe successful endoscopic removal of a biliary Wallstent one year after insertion in a patient who initially underwent placement of an expandable metal biliary stent for presumed biliary malignancy. The stent was removed after a stent related bleeding duodenal ulcer formed.

Aged↗
PubMed2000

Role of ERCP in asymptomatic orthotopic liver transplant patients with abnormal liver enzymes.

OBJECTIVE: The safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the evaluation and management of biliary tract complications after orthotopic liver transplantation (OLT) have been previously demonstrated. However, the role of ERCP in evaluating asymptomatic OLT patients with abnormal liver enzymes with a previously normal biliary tree remains poorly defined. We sought to assess the utility of ERCP in this subset of patients. METHODS: A retrospective analysis of-asymptomatic OLT patients with abnormal liver enzymes evaluated by ERCP was undertaken. In addition to ERCP, all these patients had a diagnostic abdominal Doppler ultrasound, and a percutaneous liver biopsy. All patients had choledochocholedochostomy at the time of transplant and normal T-tube cholangiograms 3 months postoperatively. A radiologist, blinded to clinical findings, interpreted the ultrasound as normal, biliary dilation, or vascular abnormalities. The same radiologist interpreted ERCP findings. A pathologist, blinded to clinical findings, graded liver biopsies as normal, diagnostic, or abnormal but nondiagnostic. RESULTS: Twenty-two patients underwent 23 ERCPs. Twenty-two of the 23 ERCPs were normal (96%), and one abnormal ERCP finding did not explain the liver enzyme abnormality. Liver biopsy was diagnostic in 13 of 22 (57%) and in each case the ERCP was normal. The remaining 10 liver biopsies were abnormal but nondiagnostic. Ultrasound was abnormal in five of 22 cases, but in the three cases suggesting biliary dilation, the ERCP was interpreted as normal. CONCLUSION: Routine use of ERCP in evaluation of asymptomatic OLT patients with liver function test abnormalities and normal cholangiograms at 3 months was not diagnostically useful. In this subset of patients, liver biopsy was usually abnormal and frequently diagnostic and should be the initial invasive diagnostic procedure.

Adult↗
PubMed2000

Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.

Metallic stents are currently an established component of the endoluminal treatment of stenoses within the blood vessels, bile ducts, esophagus, trachea, and bronchi. With the development of newer stent designs and delivery systems and the general momentum toward minimally invasive therapies, metallic stent placement has expanded into the nonsurgical therapy for gastroduodenal and colorectal obstructions. The use of metallic stents within the stomach, duodenum, or colon is intended not to be curative but to provide nonsurgical palliation for the symptoms of gastric or colonic obstruction. This palliation may be intended for the life of the patient in the case of unresectable disease or as a temporizing procedure prior to a definitive surgical procedure. In the latter clinical scenario, the benefits of a minimally invasive intestinal decompression procedure include (a) quick and noninvasive relief of the intestinal obstruction in an acutely ill patient that obviates a more extensive procedure; (b) allowance of time to improve a patient's overall medical condition and thus to allow a patient to better tolerate the definitive surgical procedure; and (c) reduction of the complexity of the definitive procedure by eliminating the need for staged procedures and allowing the definitive procedure to be performed at one setting.

Colonic Diseases↗
PubMed2000

Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding.

OBJECTIVE: To assess the results of direct percutaneous endoscopic jejunostomy (DPEJ) as a method for jejunal feeding. PATIENTS AND METHODS: We conducted a retrospective study of all patients who were referred for DPEJ between October 1998, when the procedure was implemented at our institution, and January 2000. Medical records were reviewed to assess technical success, complications, and the need for repeat procedures. Patient satisfaction with DPEJ was also evaluated by means of standardized telephone interviews. RESULTS: In 26 (72%) of 36 patients, DPEJ placement was successful. During the mean follow-up of 107 days, none of the patients with DPEJ required reintervention for tube malfunction or displacement. Two patients developed a persistent enterocutaneous fistula following the removal of the DPEJ tube. No other procedure-related complications were noted. Fifteen (78%) of 19 patients who responded to follow-up questions reported an overall satisfaction rating of 8 or higher on a 10-point scale (1, completely dissatisfied, to 10, completely satisfied). CONCLUSIONS: We conclude that DPEJ is an effective and safe method for providing jejunal tube feeding. A low reintervention rate along with high patient satisfaction makes DPEJ an attractive alternative to the more commonly placed jejunostomy feeding tubes.

Adult↗
PubMed1999

Biliary sludge.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1999

Evaluation and endoscopic palliation of cholangiocarcinoma. Management of cholangiocarcinoma.

Patients with a cholangiocarcinoma usually develop symptoms of biliary obstruction which dominate the course of their illness. At presentation, the diagnosis may be difficult to establish due to the desmoplastic nature of this tumor. Location and extent of the tumor, however, are more effectively evaluated by current radiologic techniques. Following these staging procedures, most patients are found to be unsuitable for curative resection. Therefore, establishing effective biliary drainage to relieve symptoms of obstruction becomes the most critical therapeutic goal in these patients. In the past, surgical biliary bypass procedures were advocated, but were associated with high perioperative morbidity and mortality rates. Endoscopic biliary stenting produces quick and effective relief of symptoms from biliary obstruction due to cholangiocarcinoma. Initially, successful biliary drainage is possible in most patients. However, subsequent stent occlusion or spread of tumor into nonstentable intrahepatic ducts leads to recurrent jaundice. Local therapies including (192)Ir brachytherapy and photodynamic therapy may prevent or postpone these problems.

Bile Duct Neoplasms↗
PubMed1999

Stenotrophomonas (Xanthomonas) maltophilia infection in necrotizing pancreatitis.

CONCLUSION: Although the therapy of infected pancreatic collections or organized pancreatic necrosis remains surgical, we have demonstrated that infected organized pancreatic necrosis can be treated endoscopically. BACKGROUND: Stenotrophomonas (Xanthomonas) maltophilia has been increasingly recognized as a nosocomial pathogen associated with meningitis, pneumonia, conjunctivitis, soft tissue infections, endocarditis, and urinary tract infections. This organism is consistently resistant to imipenem, a drug commonly employed in patients with necrotizing pancreatitis to prevent local and systemic infections. METHODS AND RESULTS: We report the first case of infected pancreatic necrosis by S. (X.) maltophilia. Our patient was treated successfully with endoscopic drainage of the pancreatic fluid collection and appropriate antibiogram-based antibiotic therapy. Endoscopic drainage has emerged as one of the treatment modalities for pancreatic fluid collections.

Bacterial Infections↗