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Biomedical subjects

T L Tio

Publications and source records attributed to T L Tio.

At least 55 records · Page 3Linked to original sources
PubMed1989

Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system.

Transesophageal endosonography and computed tomography were performed preoperatively in 74 patients with an esophageal carcinoma. The results were correlated with the histology of resected specimens according to the new (1987) TNM classification. Endosonography was superior to computed tomography in the evaluation of the depth of tumor infiltration, especially in the early stages and in nonresectable carcinoma (overall accuracy: endosonography 89%, computed tomography 59%). Endosonography was also more accurate than computed tomography in the assessment of regional lymph node metastases (overall accuracy: endosonography 80%, computed tomography 51%). The incidence of lymph node metastasis increased with the progression of the depth of tumor infiltration. The definitive exclusion factor for endosonography is severe stenosis, which cannot be passed with the instrument (26% of the cases). In these cases computed tomography was superior to endosonography in diagnosing celiac lymph node metastasis (overall accuracy: computed tomography 82%, endosonography 68%).

Adult↗
PubMed1989

Primary non-Hodgkin's lymphoma of the stomach: changing aspects and therapeutic choices.

Eighty-five consecutive patients, seen between 1970 and 1987, with primary gastric non-Hodgkin's lymphoma were studied to evaluate diagnostic findings and treatment results. At endoscopy three main patterns were recognized: ulceration (n = 21), diffuse infiltration (n = 16) and a polypoid mass (n = 26). Recently, the new technique of endoscopic ultrasonography was used to measure depth of infiltration and regional lymph nodes. Preoperative diagnosis altered the indication of surgery. Since 1978 surgical staging was performed in only 29% of the patients compared to 90% in the earlier period. In the later period stage II was more systematically treated with a combination of chemotherapy and radiotherapy. Over the whole period patients in stage I (n = 52) had a 5 year disease-free survival of 63%. In stage II 38% had a 5 year disease-free survival. Complications were one perforation and one haemorrhage after radiotherapy and two cases of haemorrhage after radiotherapy combined with chemotherapy. Intraabdominal recurrences were found in two cases. Recognition of endoscopic features may lead to early detection and ultimately improved survival.

Adult↗
PubMed1989

Esophagogastric carcinoma: preoperative TNM classification with endosonography.

Endosonography (ES) was preoperatively performed in 91 patients with esophageal carcinoma and 80 with gastric carcinoma. Imaging findings were correlated with those from histologic analysis of resected specimens. ES was accurate in assessment of the depth of tumor infiltration. Early-stage disease could be distinguished from advanced carcinoma. Overall accuracy of ES was 90% for assessment of esophageal carcinoma and 83% for gastric carcinoma. Stenosis was a limiting factor for accurate staging (16% of cases). ES was reasonably accurate in assessment of lymph node metastasis: Overall accuracy was 82% for the esophagus and 66% for the stomach. For nonmetastatic lymph nodes, however, the accuracy was low (56% or less for both esophagus and stomach). Difficulties occurred in distinguishing inflammation from micrometastatic lymph node involvement. ES was not accurate for diagnosis of distant metastases due to limited penetration of ultrasound. Prevalence of lymph node metastasis increased with the progression of tumor infiltration. Technical improvements, such as a smaller diameter echoprobe, may further enhance diagnostic accuracy of ES.

Adolescent↗
PubMed1989

Preoperative TNM classification of gastric carcinoma by endosonography in comparison with the pathological TNM system: a prospective study of 72 cases.

Prospectively, 72 patients with a gastric carcinoma were studied endosonographically before surgery. The results were correlated with those obtained with the histology of resected specimens according to the new (1987) TNM classification. Endoscopic ultrasonography (EUS) was accurate in assessing the extent and depth of tumor infiltration. Early gastric carcinoma could readily be distinguished from advanced carcinoma. The overall accuracy of EUS was 84.7%. Occasionally, overstaging and understaging occurred. Stenosis was a factor limiting accurate staging. EUS was reasonably accurate in the assessment of lymph node metastasis. The overall accuracy was 81.0%. In non-metastatic lymph nodes, however, the accuracy was only 50%. Difficulties occurred in distinguishing granulomatous lymph nodes and small micrometastatic lymph node involvement. EUS was not accurate in diagnosing distant metastasis, due to the limited depth of penetration of ultrasound. Technical improvements such as a reduction in the diameter of the echoprobe, and the use of the biopsy channel for EUS-guided cytological puncture will further enhance the accuracy of EUS.

Adolescent↗
PubMed1988

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement.

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.

Adult↗
PubMed1987

Pancreatitis associated with congenital duodenal duplication cyst in an adult.

A case is reported of an adult patient with a history of relapsing pancreatitis. A soft duodenal submucosal lump was found by endoscopic retrograde cholangio-pancreaticography (ERCP). Endoscopic ultrasonography (endo-US) showed an anechoic lesion covered with normal duodenal wall structure. Histology of the surgically resected cyst confirmed the diagnosis. Since surgery no further attacks of pancreatitis have occurred.

Adult↗
PubMed1986

Endoscopic ultrasonography of non-Hodgkin lymphoma of the stomach.

Endoscopic ultrasonography was performed in 8 patients with non-Hodgkin lymphoma of the stomach. Findings consisted of intramural infiltration or mucosal alteration together with perigastric lymph nodes, or both. Lymph node involvement was suggested by the presence of inhomogeneous hypoechoic echopatterns with clearly demarcated borders. Endoscopic ultrasonography was more accurate than computed tomography scan in the detection of transmural extent of malignancy and adjacent lymph node involvement. Because of the limited penetration depth of endoscopic ultrasonography, approximately 10 cm, more distant lymph nodes might be more clearly detected with computed tomography scan. Endoscopic ultrasonography was also more accurate than endoscopy and barium meal in the assessment of gastric wall infiltration. The resectability of gastric non-Hodgkin lymphoma was reliably detected by endoscopic ultrasonography before surgery. Endoscopic ultrasonography appears to be a sensitive diagnostic modality for detection, staging, and follow-up in gastric non-Hodgkin lymphoma. Technical improvements may further enhance the diagnostic value of this new procedure.

Adult↗
PubMed1986

Endoscopic ultrasonography of an arteriovenous malformation in a gastric polyp.

A case of arteriovenous malformation in a gastric polyp in a 60-year-old male complicated by profuse bleeding after endoscopic polypectomy, and treated successfully by emergency surgery, is presented. The vascular abnormality was clearly visualized by endoscopic ultrasonography (EUS) prior to endoscopic removal of the polyp. Although endoscopic coagulation of the pedicle proceeded slowly and with the utmost care causing apparently adequate coagulation of the stalk, the depth, of coagulation appeared insufficient to prevent major haemorrhage. From this experience we would be inclined to recommend EUS examination of the pedicle of large polypoid lesions to document the size of the vascular structure before endoscopic transection is carried out.

Arteriovenous Malformations↗
PubMed1986

Endoscopic ultrasonography of normal and pathologic upper gastrointestinal wall structure. Comparison of studies in vivo and in vitro with histology.

Endoscopic ultrasonographic analysis of the upper gastrointestinal wall was performed in vivo (preoperatively) and in vitro (resection specimen or postmortem material). The images obtained were correlated with histology. The normal intestinal wall was visualized as a five layer structure. The wall structure was interpreted as abnormal when partial or total destruction of the wall architecture was visualized. A diffuse submucosal hypoechoic structure without penetration into the muscularis propria was indicative of a benign lesion. Diffuse irregular hypoechoic echo pattern penetrating into the muscularis propria, with or without alteration of the mucosal layer, was usually found in linitis plastica. As a rule, early gastric cancer could readily be differentiated from advanced gastric cancer when penetration of the lesion into the muscularis propria appeared to be absent. Follow-up EUS was helpful in the differentiation between a benign and malignant ulcer. Remaining sonographic abnormalities after successful treatment of an ulcer was compatible with malignancy. Further in vivo and vitro studies must be performed to determine the accuracy and limitations with which the ultrasonographic findings are interpreted.

Digestive System↗
PubMed1986

Endoscopic ultrasonography in detection and staging of gastric non-Hodgkin lymphoma. Comparison with gastroscopy, barium meal, and computerized tomography scan.

Endoscopic ultrasonography (EUS) was performed in 10 patients with gastric non-Hodgkin lymphoma (NHL). EUS visualized hypoechoic intramural lesions with destruction of normal gastric wall architecture together with perigastric lymph node involvement. EUS was more accurate than endoscopy, barium meal, and computerized tomography scan in detecting and staging gastric NHL because of the high resolution. The non-resectability could reliably be diagnosed before surgery based on the detection of deep infiltration of the lesion into the surrounding tissues and/or organs EUS appears to be a sensitive diagnostic modality for detecting, staging, and following up after chemotherapy of gastric NHL. Technical improvements allowing ultrasonically guided biopsy or cytological puncture may further enhance its diagnostic usefulness.

Adult↗
PubMed1986

The role of endoscopic ultrasonography in assessing local resectability of oesophagogastric malignancies. Accuracy, pitfalls, and predictability.

Preoperative EUS was performed in 62 patients with oesophagogastric malignancy. The results were prospectively correlated with surgery and the histology of the resected specimens. Overall, a high degree of accuracy was obtained in EUS staging of the lesion and metastatic lymph node involvement. Clearly demarcated intramural hypoechoic structures with or without regional lymph node involvement indicated local resectability. Involvement of multiple distant lymph nodes predicted the palliative nature of the procedure. Deep infiltration of the tumour into the surrounding tissues and/or organs strongly suggested non-resectability. Differentiation between reactive and metastatic lymph node enlargement was occasionally difficult. Technical improvements enabling guided cytologic puncture may further enhance the diagnostic value of EUS.

Adult↗
PubMed1986

Comparison of blind transrectal ultrasonography with endoscopic transrectal ultrasonography in assessing rectal and perirectal diseases.

Blind transrectal ultrasonography (BUS) and endoscopic transrectal ultrasonography (EUS) were performed in 10 patients with rectal cancer, in 5 with rectal adenomas, and in 5 with benign perirectal disease. BUS and EUS were equally accurate in staging advanced rectal cancer. EUS was more accurate than BUS in assessing small tumors localized in the mucosa and/or submucosa. Adjacent lymph node abnormality was more clearly visualized with EUS because of the high resolution of this instrument, using a 7.5-MHz ultrasonic beam. In contrast, distant lymph node involvement was more readily seen with BUS because of the penetration depth of this 5-MHz beam. Differentiating rectal adenoma from rectal adenoma with malignancy was easier with EUS than with BUS. Perirectal disease was more accurately visualized with BUS than with EUS. Further studies in a larger number of patients are necessary to document fully the accuracy and limitations of both new diagnostic modalities.

Abscess↗
PubMed1986

Endoscopic ultrasonography in staging local resectability of pancreatic and periampullary malignancy.

Endoscopic ultrasonography (EUS) was performed before surgery in 14 patients with pancreatic cancer and in 9 patients with periampullary carcinoma. EUS enabled accurate determination of the extent of the lesions and the presence of suspicious lymph node enlargements. Carcinoma deeply infiltrating into the surrounding structures and major blood vessels was strongly indicative of local non-resectability. In contrast, clearly defined well-circumscribed hypoechoic tumours with no evidence of distant lymph node involvement were compatible with local resectability. The presence of multiple enlarged lymph nodes with irregular echo pattern adjacent to the major blood vessels (hepatic artery, coeliac trunk, aorta) surrounding locally resectable tumours was indicative of the palliative nature of the resection. Technical improvement, in particular the possibility of guided cytological aspiration, may further enhance the diagnostic value of this new imaging technique.

Adult↗
PubMed1986

Endoscopic ultrasonography of bile duct malignancy and the preoperative assessment of local resectability.

Endoscopic ultrasonography (EUS) was performed before surgery in 12 patients with Klatskin tumour and in 8 patients with distal common bile duct carcinoma. The usual EUS findings consisted of an intraductular mass lesion together with adjacent lymph node involvement. The depth of malignant infiltration into the surrounding tissues could clearly be seen, which was of utmost importance in assessing local resectability. A clearly demarcated malignant growth with or without evidence of loco-regional lymph node involvement was considered compatible with local resectability. Involvement of distant lymph nodes along major blood vessels was thought to indicate palliative resection. Evidence of deep infiltration of the malignancy into the surrounding tissues (mesenteric artery, coeliac trunk, aorta) and/or organs (liver metastasis) was considered to indicate non-resectability. From this study EUS appears to be a sensitive modality for detecting, staging, and preoperative assessment of local resectability in bifurcation tumours and in distal bile duct malignancy. Technical improvements enabling guided cytological puncture and reducing the length of the rigid tip may further enhance its diagnostic value.

Adenoma, Bile Duct↗
PubMed1986

Endoscopic ultrasonography in analysing peri-intestinal lymph node abnormality. Preliminary results of studies in vitro and in vivo.

Endoscopic ultrasonography (EUS) was performed on fresh postmortem material, intraoperatively in patients with lymph node abnormality, preoperatively (in vivo), and on corresponding resection specimens (in vitro). Well-defined round or ellipsoid structures adjacent to the intestinal wall, manifesting a more hypoechoic pattern than the surrounding tissues, were interpreted as lymph nodes, which was confirmed by histology. Lymph nodes with an inhomogeneous echo pattern, either similar or more hypoechoic than the pattern of the primary lesions and revealing sharply demarcated borders, were interpreted as highly suggestive of malignancy. In contrast, lymph nodes with a homogeneous but more hyperechoic pattern than that of primary lesions with non-sharply delineated (pseudopoid) boundaries were indicative of inflammatory changes. Small micrometastatic lymph nodes were difficult to detect and often missed. Moreover, lymph nodes that could not be brought adequately into the focus of the ultrasonic beam were not clearly identified. Further studies both in vivo and in vitro, particularly preoperatively and intraoperatively, should be performed to enhance our knowledge and accuracy in interpreting lymph node abnormalities.

Endoscopy↗
PubMed1984

Endoscopic ultrasonography in the assessment of intra- and transmural infiltration of tumours in the oesophagus, stomach and papilla of Vater and in the detection of extraoesophageal lesions.

Conventional ultrasonography is widely used as a diagnostic investigation in gastroenterology. Ultrasonically visible 'target or halo sign' caused by lesions in the upper GI-tract has no specificity or biological significance, so conventional ultrasonography cannot be used as an adequate investigation for detecting lesions in the upper GI-tract. Recently endoscopic ultrasonography was developed with the aim of improving the diagnostic potentialities of ultrasonography. Using an ultrasonic device it is now possible not only to detect lesions in the upper GI-tract, but also to assess the exact extent and depth of both local infiltration and adjacent metastases. Rapid differentiation between intramural and extraluminal lesions can readily be accomplished. The superiority of this new technique in the diagnosis of tumours of the papilla of Vater, and in particular in establishing preoperative tumour staging, has been demonstrated in comparison with other imaging techniques. These preliminary results in a small number of patients must be confirmed by further studies involving clinical trials with a large number of patients.

Adenocarcinoma↗