Colonoscopically reduced intussusception and testicular involvement in Henoch-Schonlein purpura.
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BACKGROUND/AIMS: Premedication for endoscopy promotes patient cooperation and makes subsequent examinations more acceptable. Music therapy is widely used in the treatment of acute and chronic pain. Therefore, we investigated the effects of music therapy on pain and on salivary cortisol levels in patients undergoing screening colonoscopy. METHODOLOGY: The subjects were 29 consecutive patients undergoing colonoscopy for various reasons. Patients were randomly assigned to undergo colonoscopy while listening to music (n=15) or while not listening to music (n=14). Cortisol levels were measured in samples of saliva obtained before and after colonoscopy. After colonoscopy, patients were asked to rate their maximum pain during colonoscopy. RESULTS: Patients who listened to music during colonoscopy tended to have lower pain scores. Salivary cortisol levels increased significantly less in the group receiving music. CONCLUSIONS: Music therapy during colonoscopy markedly reduces fear-related stress, as indicated by changes in salivary cortisol levels.
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We present the method of laparoscopicaly assisted polypectomia as yet another option for management of large and poorly accessible polyps of the large intestine. The above method has been applied in 13 cases in 10 patients. In our study group, no perforations of the intestinal wall have occurred. The above procedure has been assessed as of minor stress for the patient.
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Despite the frequency with which polypectomy is performed, there is a paucity of information on what technical aspects of polypectomy most effectively remove polyps and minimize complications. The practice of polypectomy is based largely on the observational experience of experts and what gastroenterology fellows have learned from their attending physicians and from experts in postgraduate courses. Moreover, polypectomy technique is not consistent across the United States. In this technique update, the author presents his own methods for treating and observing small, large pedunculated, and large sessile polyps and discusses the advantages, disadvantages, and complications of each technique.
We studied the usefulness and accuracy of a flexible endoscopic ultrasound system (EUS) in preoperative staging of tumor invasion and involvement of lymph nodes of rectal tumors. Comparison of preoperative EUS findings with histopathologic TNM classification (UICC 1987) was possible in 12 patients. The depth of tumor invasion was correctly staged in 9/12 patients (75%), and lymph node staging was correctly predicted in 9/12 patients (75%). Our results indicate that flexible coloscopic ultrasonography is as accurate as rigid systems for staging of colorectal cancer. It will become a sensitive method for early diagnosis of local recurrence. The flexible endoscopes are well tolerated by patients and more proximal lesions which cannot be reached with the rigid instruments can also be examined.
Intussusception of the appendix is an extremely rare condition. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. We report a case of appendiceal intussusception secondary to endometriosis in an otherwise healthy female. The case was diagnosed preoperatively by colonoscopy and treated surgically at laparoscopy. We review the literature of appendiceal intussusception and discuss the associated conditions, diagnosis, and a classification scheme for this unusual finding.
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A 68-year old female underwent removal of a 3 cm transverse colon polyp, which contained adenocarcinoma, by means of endoscopic polypectomy. She tolerated the procedure well. Unfortunately, six hours later she returned to the hospital with vague abdominal complaints. Her clinical exam revealed mild abdominal tenderness, but was not suggestive of a perforated viscus. Radiographic data revealed retroperitoneal, mediastinal, and free intraperitoneal air, along with intramural bowel wall air.
Two cases of ileocecal tuberculosis are presented. The diagnosis was achieved by endoscopic fine needle aspiration cytology (FNAC), while endoscopic biopsies and brush cytology were negative. The usefulness of endoscopic FNAC in the diagnosis of gastrointestinal tract tuberculosis is highlighted.
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