Endoscopic Use

An endoscopic applicator with a vacuum device has been developed. This enables endoscopic application and suction of a tumor into the device with subsequent application of drugs /genes and pulses. A study in veterinary clinics in spontaneous tumors in dogs has been carried out successfully (D. Soden, personal communication), and a phase 1 clinical trial has now opened for patients suffering from colorectal cancer (www.clinicaltrials.gov NCT01172860). 

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Disinfectants are used in janitorial suppHes for hospitals and the home to treat toilet bowls, floors and walls in sick rooms, operating rooms, and wherever infective microorganisms are a problem. Instmments such as scalpels, scissors, catheters, and endoscopes used to invade tissues are treated with disinfectants, as are dental instmments. Laws require that hospital waste must be disinfected so that bacteria and vimses, such as the hepatitis vims and the AIDS vims, do not infect hospital workers and people in the community. 

Plastic endoprosthesis for biliary drainage were introduced in 1978 by Burcharth (1978) and Pereiras et al. (1978). Several types are available for percutaneous and endoscopic use. Common examples include the hammer endoprosthesis (William Cook), and the Carey-Coons endoprosthesis (Boston Scientific). Most plastic endoprostheses have sideholes at either end and are of large caliber to ensure efficient biliary drainage. 

Some of the CCDs mentioned above are a few millimeters in diameter. Such a CCD could be placed at the distal end of an endoscope and used for imaging, instead of the ordered bundle of optical fibers. A light guide is still used in these endoscopes for illumination. Such endoscopes can provide imaging at a video rate from internal organs and they are called videoscopes. It is estimated that roughly 50% of the flexible endoscopes used today are videoscopes. These endoscopes are still relatively thick and they are mostly used in gastroscopy and colonoscopy. 

Fig. 7.1a-d. An endoscope used for endoscopic MR imaging is not very different from other gastroscopes, but it is manufactured with materials that do not produce artefacts which interfere with imaging, a The endoscope used by Dux et al (2001). The tip of the endoscope b shows the oversized biopsy channel that is used to advance the coil into the stomach, c The prototype of the receiver coil used nowadays. The diameter of the coil released from the endoscope is variable depending on the size of the tumour that is to be imaged, d shows that the endoscope is compatible with MRI, and the channel that accommodates the receiver coil is clearly depicted... 

Patients received Photofrin, 2 mg/kg, and 2 days later were treated endoscopically using a diffuser fiber (usually 1 to 2.5 cm) delivering 200 J/cm diffuser length at 630 nm. As these lesions are very thin, the... 

At present, all over the world the X-ray television systems, instruments based on magnetic heat and eddy-current methods are used to check the air-passengers luggage and to check staff when entering the hazardous objects. In banks, security services and etc. the optic-television and endoscopic technical vision systems are widely used. 

Theory and Equipment. Many diseases of the human body can be identified by visual appearance. Tumors in the upper gastrointestinal (GI) tract, for example, possess a characteristic salmon pink color (3). The presence of such a color can be an indication of disease. Endoscopy is the medical imaging tool used to detect such colors in the inside of hoUow internal organs such as the rectum, urethra, urinary bladder, stomach, colon, etc. An endoscope is the instmment used to perform endoscopy. Endoscopic imaging involves the production of a tme color picture of the inside of the human body using lenses and either hoUow pipes, a fiber optic bundle, or a smaU CCD camera. AU three use a large field-of-view, sometimes referred to as a fish eye, lens to aUow a 180° field of view. 

The largest use of endoscopic techniques is in the examination of the gastrointestinal tract. Upper intestinal endoscopy is the examination of the esophagus, stomach, and proximal duodenum. Colonoscopy is the examination of the colon, large intestine, and in some cases the distal parts of the small intestine. Cholangiopancreatography is the examination of the biUary tree and pancreas. 

Each of the endoscopic imaging procedures is relatively risk free and painless when performed by competent and weU-trained individuals using a local anesthetic. Eetoscopy has the highest risk. There is a 10% increased probabiUty of premature deUvery and 10% higher fetal loss rate. 

Automation of disinfection procedures, e.g. use of automatic machines, still with a good standard of general ventilation, for disinfecting endoscopes... 

Ease of use 2-6°C storage. Multiple application devices (linear, spray tips, endoscopic, etc.), 20 min preparation time. Set-up time = 30 s-3 min. May wash away in presence of active bleeding. Requires trained personnel to operate equipment. Preparation time required to obtain plasma component. Room temperature storage. 5 min preparation time. Single syringe applicator per kit. Set-up time - 3 min. Effective at site of active bleeding. 

Midazolam (Versed), a short-acting benzodiazepine CNS depressant, is used as a preanesthetic drug to relieve anxiety for induction of anesthesia for conscious sedation before minor procedures, such as endoscopic procedures and to supplement nitrous oxide and oxygen for short surgical procedures. When the drug is used for induction anesthesia, the patient gradually loses consciousness during a period of 1 to 2 minutes. 

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

An alternative method of managing patients with cerebellar infarction causing obstructive hydrocephalus is endoscopic third ventriculostomy. Baldauf et al. ° reviewed 10 cases managed by the use of endoscopic third ventriculostomy, 8 of whom had clinical improvement (measured as an improvement in the level of consciousness). This therapy is still experimental, and improvement in outcome has not been demonstrated. 

Humans Hydrogen peroxide has been used as an enema or as a cleaning agent for endoscopes and may cause mucosal damage when applied to the surface of the gut wall. Hydrogen peroxide enteritis can mimic an acute ulcerative, ischaemic or pseudomembranous colitis, and ranges from a reversible, clinically inapparent process to an acute, toxic fulminant colitis associated with perforation and death (Bilotta and Waye, 1989). It is conceivable that anecdotal reports of exacerbation of IBD by iron supplementation (Kawai et al. 1992) are mediated by hydroxyl radical production by the Fenton reaction. 

Endoscopic approaches are typically used and may include colonoscopy, proctosigmoidoscopy, or possibly upper GI endoscopy in patients with suspected CD. Endoscopy is useful for determining the disease distribution, pattern and depth of inflammation, and to obtain mucosal biopsy specimens. Supplemental information from imaging procedures, such as computed tomography (CT), abdominal x-ray, abdominal ultrasound, or intestinal barium studies may provide evidence of complications such as obstruction, abscess, perforation, or colonic dilation.3... 

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