RESUMEN
The treatment of patients with chronic gastrointestinal bleeding can be a frustrating diagnostic challenge. In the past 10-15 years, a variety of new diagnostic procedures (e.g., fiber-optic endoscopy, scintigraphy, and double-contrast barium studies) have become available to examine these patients. Despite these new procedures, a small number of patients continue to bleed without a defined cause. We sought to evaluate the role of visceral angiography in patients with chronic gastrointestinal bleeding in whom findings on an extensive noninvasive workup have been normal. Between 1983 and 1990, we obtained angiograms on 36 such patients. The cause of bleeding was established by angiography in 16 patients (44%). In 11 of these 16, angiography revealed only a structural abnormality without active bleeding. Twenty patients had normal angiographic findings. No angiograms were false-positive, but three were false-negative (8%). No complication occurred as a result of the angiographic procedures. Our experience shows that visceral angiography can provide a positive diagnosis in a significant number of patients with chronic gastrointestinal bleeding of obscure origin in whom all other diagnostic measures have been unrevealing. Despite improvements in noninvasive diagnostic techniques, angiography still remains an important tool for examining this group of patients.
Asunto(s)
Angiografía , Hemorragia Gastrointestinal/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Retained biliary stones remain a common clinical problem in patients after surgery. Since 1984, the authors have used choledochoscopy in the treatment of suspected retained biliary stones in 75 patients. These procedures were performed in the radiology department with use of local anesthesia supplemented by an intravenously administered sedative and analgesic. A 15-F flexible fiberoptic choledochoscope was used. Fifty-one of the 75 patients were treated as outpatients. Treatment was successful in 74 of 75 patients; in one patient, intrahepatic stones were not completely removed. Electrohydraulic lithotripsy was used to fragment calculi in 11 patients (15%). Biopsies were performed in four patients (5%). Five minor complications occurred; three required overnight admission. Choledochoscopic-assisted removal of retained biliary calculi is a highly effective and safe procedure. Advantages over standard fluoroscopic stone removal include the ability to directly visualize and fragment adherent or impacted stones and visualize noncalculous filling defects, such as air bubbles, mucus, and biliary tumors.
Asunto(s)
Colelitiasis/terapia , Endoscopía del Sistema Digestivo/instrumentación , Intubación/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Colelitiasis/epidemiología , Femenino , Tecnología de Fibra Óptica , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A generalized form of the Wiener digital filter is described in which the user interactively varies two filter parameters to produce any desired number of filtered versions of a given image with differing blends of sharpening and smoothing qualities. Filtering is performed sufficiently rapidly, even without use of an array processor, to make application of the filter truly interactive. Use of the filter is illustrated with typical nuclear medicine images.