Clifford S. Melnyk

Fiberoptic Pansigmoidoscopy:An evaluation and comparison with rigid sigmoidoscopy

A flexible 60-cm fiberoptic sigmoidoscope was evaluated in 139 patients. In 120 patients flexible sigmoidoscopy was compared with routine rigid sigmoidoscopy with respect to patient tolerance, distance of inspection, procedure time, and diagnostic yield. All patients were prepared with a single cleansing enema, and given no analgesia. Despite the fact that the flexible instrument was inserted nearly 3 times as far into the colon (55 cm versus 20 cm), more patients preferred the flexible examination. Significant pathological lesions were discovered by the flexible examination in 39% of patients, whereas rigid sigmoidoscopy discovered lesions in only 13%. Fluoroscopy performed during flexible sigmoidoscopy in 19 additional patients revealed that the instrument tip had reached the descending colon or beyond in 84% of patients. There were no complications. The flexible fiberoptic pansigmoidoscope offers promise as a practical diagnostic tool for a rapid and complete examination in patients with suspected colorectal diseases.

Small-bowel enema - An underutilized method of small-bowel examination

The results of 88 consecutive small-bowel enemas were compared retrospectively with the results of 52 routine small-bowel series and 50 barium enemas done in the same patients. Ninety-six percent of the diagnoses made by small-bowel enema were correct, as compared to only 65% made by routine small-bowel series. The incorrect studies were mostly false negatives and the abnormalities missed included regional enteritis, small-bowel obstruction, and intestinal lymphoma. The barium enema failed to achieve ileal reflux in 26% of patients and had a 23% false negative rate when reflux was achieved. Because small-bowel series as done by conventional methods was significantly less accurate, we believe small-bowel enema should be considered in patients with suspected small-bowel disease when other studies are negative.

GALLBLADDER AND LIVER INFARCTION OCCURRING AS A COMPLICATION OF ACUTE BACTERIAL ENDOCARDITIS

A case of acute bacterial endocarditis is presented in which gallbladder infarction and areas of hepatic infarction were documented. Selective angiography showed findings consistent with emboli to the gallbladder and hepatic circulations.

Colonic varices due to intestinal cavernous hemangiomas

SummaryColonic varices are an unusual cause of rectal bleeding. Occurring most often in the setting of portal hypertension, colonic varices have also been linked to congenital vascular lesions. One such vascular lesion, the cavernous hemangioma, is rarely found in the bowel. We report a patient with cavernous hemangiomas involving skin, lower extremities, and gastrointestinal tract, who presented with chronic rectal bleeding from colonic varices. The progression of his hemangiomatous lesions over an 18-year course is documented. The association of colonic varices and hemangiomas of the bowel is discussed.

Intestinal Malabsorption and Immunoglobulin Deficiency

Available evidence suggests that hypogammaglobulinemia, particularly immunoglobulin A (IgA) deficiency, may be associated with intestinal malabsorption and mild to moderate villous atrophy of the proximal jejunal mucosa.1-3We have encountered such a patient who responded favorably in turn to a gluten-free diet and to tetracycline hydrochloride therapy administered orally. The purpose of this report is to relate the clinical and immunological findings in this case to published data from other patients with malabsorption and documented immunoglobulin deficiencies. Methods For Special Studies The serological and tissue techniques, as well as the method used to quantify mucosal lymphoid cells employing cell density indices (CDI), have been reported.4The CDI are arbitrary units which represent cells per unit area of interstitium.4In the previous study of eight specimens of normal human rectal mucosa, the CDI (mean ± SE of the mean) for IgA-, IgM- and IgG-containing lymphoid cells were 80.14

The pansigmoidoscope: one year's experience in a gastrointestinal diagnostic unit.

Since May 1976, the Olympus pansigmoidoscope has been available for routine use at the University of Oregon Health Sciences Center. Two hundred sixty-five examinations were performed over the next year. The average distance examined was 49 cm. Time per examination ranged from 3 to 15 minutes, with an average of 8 minutes. Preparation consisted of one or two tap water enemas, except in known inflammatory bowel disease where no preparation was given. No patient received sedation and there were no complications. Small biopsy (2.8 mm), large biopsy (4.0 mm), “hot biopsy” and polypectomy were performed when indicated. The procedure was most helpful for the following indications: 1) differential diagnosis and follow-up of inflammatory bowel disease, 2) hematochezia, 3) evaluation of abnormal barium enema, 4) left-sided polypectomy, 5) diarrhea with normal barium enema, and 6) guaiac-positive stools. It was of no value in patients with abdominal pain with normal barium enema. Comparing the frequency of examinations this year with last year we found a 50% decrease in use of the rigid (25 cm) sigmoidoscope (538 to 270 exams) and a 98% decrease in use of the MB2 (100 cm) colonoscope (80 to 2 exams).