DOCSLIB.ORG

Automatic Classification of Digestive Organs in Wireless Capsule

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Automatic Classification of Digestive Organs in Wireless Capsule Automatic Classification of Digestive Organs in Wireless Capsule Endoscopy Videos Jeongkyu Lee1, JungHwan Oh2, Subodh Kumar Shah1, Xiaohui Yuan2, Shou Jiang Tang3 1Dept. Comp. Sci. & Eng. 2Dept. Comp. Sci. & Eng. 3Division of Digestive Diseases University of Bridgeport University of North Texas UTSW Medical Center Bridgeport, CT 06604 Denton, TX 76203 Dallas, TX 75390 fjelee,[email protected] fjhoh,[email protected] [email protected] ABSTRACT A human digestive system consists of a series of several Wireless Capsule Endoscopy (WCE) allows a physician to di®erent organs including the esophagus, stomach, small in- examine the entire small intestine without any surgical op- testinal (i.e., duodenum, jejunum, and ileum) and colon. eration. With the miniaturization of wireless and camera Standard endoscopy has been playing a very important role technologies the ability comes to view the entire gestational as a diagnostic tool for the digestive tract. For example, track with little e®ort. Although WCE is a technical break- various endoscopies such as gastroscopy, push enteroscopy through that allows us to access the entire intestine without colonoscopy have been used for the visualization of digestive surgery, it is reported that a medical clinician spends one system. However, all methods mentioned above are limited or two hours to assess a WCE video. It limits the number in viewing small intestine. To address the problem, Wire- of examinations possible, and incur considerable amount of less Capsule Endoscopy (WCE) was ¯rst proposed in 2000, costs. To reduce the assessment time, it is critical to develop which integrates wireless transmission with image and video a technique to automatically discriminate digestive organs technology [13, 2, 1, 12, 14, 8]. After FDA approved in 2002, such as esophagus, stomach, small intestinal (i.e., duode- it is now used as one of the important tools to examine small num, jejunum, and ileum) and colon. In this paper, we intestine. propose a novel technique to segment a WCE video into WCE allows a physician to examine the entire small in- these anatomic parts based on color change pattern anal- testine non-invasively. WCE uses a small capsule, 11 mm in ysis. The basic idea is that the each digestive organ has diameter and 25 mm in length (see Figure 1 (a)). The front di®erent patterns of intestinal contractions that are quan- end of the capsule has an optical dome where white light ti¯ed as the features. We present the experimental results emitting diodes (LEDs) illuminate the luminal surface of that demonstrate the e®ectiveness of the proposed method. the gut, and a micro camera sends images via wireless trans- mission to a receiver worn by a patient (see Figure 1 (b)). Another part of the capsule contains a small battery that Categories and Subject Descriptors can last up to 8 hours. The patient swallows a small cap- I.2.10 [Arti¯cial Intelligence]: Vision and Scene Under- sule, usually after an overnight fast. As the capsule moves standing|Video analysis; I.4.8 [Image Processing and through the gastrointestinal tract, images are transmitted Computer Vision]: Scene Analysis|Time-varying imagery by the digital radio frequency communication channel to a data recorder (see Figure 1 (c)). This data are transferred to a computer for interpretation by the specialists. The cap- General Terms sule is then passed in the patient's stool without the need Algorithms, Experimentation, Software for retrieval. Keywords Wireless capsule endoscopy, event boundary detection, event hierarchy, energy function, high frequency content function 1. INTRODUCTION (a) (b) (c) Figure 1: Wireless Capsule Endoscopy Equipments: (a) the capsule, (b) the 8-lead antenna array, and Permission to make digital or hard copies of all or part of this work for (c) receiver/recorder unit and battery. personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. To copy otherwise, to Although WCE is a technical breakthrough that allows republish, to post on servers or to redistribute to lists, requires prior specific to access the entire intestine without surgery, it is reported permission and/or a fee. SAC’07 March 11-15, 2007, Seoul, Korea that the interpretation time takes 1 or 2 hours. This is Copyright 2007 ACM 1-59593-480-4 /07/0003 ...$5.00. very time consuming for the gastroenterologist. It limits its general application and incur considerable amount of are di®erent since each digestive organ has di®erent types costs. To reduce the assessment time, Berens et al. proposed of movements and functionalities. We will characterize in- the technique for automatically discriminating stomach, in- testinal contractions to ¯nd events in WCE videos in the testine, and colon by using the Discrete Cosine Transform following subsections. (DCT) and Principal Component Analysis (PCA) classi- ¯ers [1]. However, the technique can detect only two bound- aries of stomach/intestine and intestine/colon, which is not enough to assist the specialist. In [14], ROC (Receiving Operating Characteristic) curves analysis are used for the classi¯cation of contraction and non-contraction images in (a) WCE videos. However, it is not based on the contents of WCE video. In this paper, we propose a novel algorithm for event boundary detection in Wireless Capsule Endoscopy videos based on an energy function. The basic idea is that each di- gestive organ such as esophagus, stomach, duodenum, small (b) intestine, and colon, has di®erent patterns of intestinal con- tractions. These patterns have been widely used in the anal- Figure 2: Sequence of Frames of WCE Video from: ysis of biogenic signals, such as Electrogastrogram [7] or (a) stomach and (b) small bowel. Electrocardiogram [10]. We ¯rst characterize the contrac- tions of WCE video using Energy function in a frequency domain. Then, we segment WCE video into events by us- 2.2 Feature Extraction ing a high frequency content (HFC) function. The detected To characterize the contractions in WCE videos, we tested event boundaries indicate either entrance of the next organ several di®erent features. Many works have tackled the or unusual events in the same organ, such as intestinal juices, problem of the characterization of intestinal contractions in bleedings, and unusual capsule movements. We classify the capsule endoscopy using various features [1, 12, 14]. In [14], segmented events into higher level events that represent di- 34 features are extracted to describe the contractions along gestive organs. The classi¯cation result is represented by a 9 frames: 9 mean intensities, 9 hole sizes, 9 global contrasts, tree structure, which is called an event hierarchy of WCE. 6 correlations among frame sequences, and 1 variance of in- The remainder of this paper is organized as follows. Fea- tensities. However, the approach requires high computations ture extraction and event boundary detection in WCE video to extract many features from videos, and pre-processing to are discussed in Section 2. Section 3 presents the proposed test the data, which prevent on-line processing. technique for building event hierarchy of WCE video. In We mainly focus on color features in order to pursue on- Section 4, we discuss our experimental results. Finally, Sec- line processing. Since colors are the only feature values cap- tion 5 presents some concluding remarks. tured by a camera directly, it can reflect the activities of di- gestive system e®ectively such as contractions and juices. In other words, intestinal movements, i.e. contractions, could 2. EVENT BOUNDARY DETECTION IN WCE change the color values. Among the various color domains, VIDEOS we select HSI color space. The reason we choose HSI is that In this section, we ¯rst discuss the intestinal contractions hue, saturation and intensity are most robust components of which patterns are the most important discriminator of for video and image processing [3]. digestive organs. In order to characterize the contractions, First, we convert the RGB color space into the HSI color we extract energy-based feature in frequency domain from space for every frame in WCE video. Since the intestinal WCE images, and then detect event boundaries by using a contractions that are periodic movements a®ect all compo- high frequency content (HFC) function. nents in the color space, we can use either any components among hue, saturation and intensity, or any combinations 2.1 Intestinal Contractions of components in HSI. In this paper, we use mean of entire pixel values in a frame. Figure 3 shows the average values Peristalses or contractions are intrinsic motility patterns of HSI for the ¯rst 5000 frames of a sample WCE video. in bowel movements, which is also the basic activity through- out entire gastrointestinal tract. Since the intestinal con- ABC D traction is a very good pathological indicator, it is widely used for the diagnosis of many gastrointestinal diseases. One Intensity Saturation Hue of examples using contractions is Electrogastrogram [7] (EGG). Avg. EGG is a non-invasive recording of the electrical activity Value of stomach. Slow waves are generated from the activity of the gastrointestinal wall surface, or gastrointestinal contrac- tions. Frame # WCE videos can record continuous activities in digestive system such as intestinal contractions, and visualize them Figure 3: Average values of HSI colors for the ¯rst easily. Figure 2 shows a number of examples of intestinal 5000 frames of a sample WCE video. contractions taken by WCE. Figure 2 (a) and (b) are se- quences of frames captured from stomach and small bowel, The blue, pink, and gray lines in the ¯gure indicate the respectively. As seen in the ¯gure, the motility patterns average values of hue, saturation, and intensity of each frame in a video, respectively.
Load more

Recommended publications
  • Childhood Functional Gastrointestinal Disorders: Child/Adolescent
    Gastroenterology 2016;150:1456–1468 Childhood Functional Gastrointestinal Disorders: Child/ Adolescent Jeffrey S. Hyams,1,* Carlo Di Lorenzo,2,* Miguel Saps,2 Robert J. Shulman,3 Annamaria Staiano,4 and Miranda van Tilburg5 1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’sMedicalCenter,Hartford, Connecticut; 2Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio; 3Baylor College of Medicine, Children’s Nutrition Research Center, Texas Children’s Hospital, Houston, Texas; 4Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Naples, Italy; and 5Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Characterization of childhood and adolescent functional Rome III criteria emphasized that there should be “no evi- gastrointestinal disorders (FGIDs) has evolved during the 2- dence” for organic disease, which may have prompted a decade long Rome process now culminating in Rome IV. The focus on testing.1 In Rome IV, the phrase “no evidence of an era of diagnosing an FGID only when organic disease has inflammatory, anatomic, metabolic, or neoplastic process been excluded is waning, as we now have evidence to sup- that explain the subject’s symptoms” has been removed port symptom-based diagnosis. In child/adolescent Rome from diagnostic criteria. Instead, we include “after appro- IV, we extend this concept by removing the dictum that priate medical evaluation, the symptoms cannot be attrib- “ ” fi there was no evidence for organic disease in all de ni- uted to another medical condition.” This change permits “ tions and replacing it with after appropriate medical selective or no testing to support a positive diagnosis of an evaluation the symptoms cannot be attributed to another FGID.
    [Show full text]
  • Electrogastrography: Methodology, Validation and Applications
    J Neurogastroenterol Motil, Vol. 19 No. 1 January, 2013 pISSN: 2093-0879 eISSN: 2093-0887 http://dx.doi.org/10.5056/jnm.2013.19.1.5 Review JNM Journal of Neurogastroenterology and Motility Electrogastrography: Methodology, Validation and Applications Jieyun Yin* and Jiande D Z Chen Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas, USA; and Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, China Electrogastrography (EGG) is a non-invasive method for the measurement of gastric myoelectrical activity. It was first dis- covered in 1921 and popularized in 1990s. EGG is attractive because it is non-invasive. However, due to its non-invasive na- ture, there have also been controversies regarding validity and applications of EGG. The aim of this review is to discuss the methodologies, validation and applications of EGG. Pros and cons of EGG will also be discussed in detail. First, the gastric slow wave and its correlation with gastric motility are presented. The association between gastric dysrhythmia and impaired gastric motility is reviewed. Secondly the method for recording the electrogastrogram is presented in detail and pitfalls in the recording and analysis of EGG are discussed. Thirdly, findings reported in the literature demonstrating the accuracy of EGG in recording gastric slow waves and gastric dysrhythmia are reviewed and discussed. The correlation of the electrogastrogram with gastric contraction is carefully discussed. Finally, applications of EGG in a few major areas are reviewed. (J Neurogastroenterol Motil 2013;19:5-17) Key Words Electrogastrography; Gastric slow waves; Gastrointestinal motility The EGG was first introduced in 1922 by Alvarez,1 redis- covered by Davis et al2 in 1957 and popularized in 1990s.3 Due to Introduction its non-invasive nature, EGG has received substantial attention Electrogastrography is a non-invasive technique for recording among researchers and clinicians and also the controversies and gastric myoelectrical activity using cutaneous electrodes placed concerns arosed.
    [Show full text]
  • 24-Hour Ambulatory Electrogastrography in Healthy Volunteers
    24-Hour Ambulatory Electrogastrography in Healthy Volunteers G. LINDBERG, M. IWARZON & B. HAMMARLLJND Karolinska Institutet, Section of Gastroenterology and Hepatology, Dept. of Medicine, Huddinge University Hospital, Huddinge, Sweden Lindberg G, Iwarzon M,Hammarlund B. 24-Hour ambulatory electrogastrography in healthy volunteers. Sand J Gastroenterol 1996;31:658-664. Background: Development of electrogastrography, the recording of gastric electric rhythm from cutaneous electrodes, for clinical purposes has been hampered by methodologic problems and the lack of an ambulatory technique. We have evaluated a newly developed system for ambulatory electro- gastrography. Methods: 24-Hour recordings were obtained from 30 healthy volunteers. We used digital filtering, a Hamming window, and spectral analysis to determine the dominant frequency of successive 256-sec segments of data. Results: Low-frequency noise disturbed the primary signal. After secondary filtering a stable normogastric (24cpm) rhythm was present during a median of 49% (range, 3679%)of the recording time. The mean frequency of gastric electric activity varied from 2.92 2 0.15 cprn (mean 2 SD) at mid-day to 2.72 2 0.13 cprn in the late night. Conclusions: Ambulatory recording of electrogastrography needs technical improvement. The electrogastrogram shows a circadian variation in frequency. Key words: Electrodes; electrodiagnosis; gastrointestinal motility, computer-assisted signal processing; human; reference values; stomach Greger Lindberg, M.D., Section of Gastroenterology and Hepatology, Dept. of Medicine, K63, Huddinge University Hospital, S-141 86 Huddinge, Sweden (fax: + 46 8 6082241) The recording of gastric electric activity from cutaneous arrive at a so-called running spectral analysis (10, 11). Thus, electrodes, so-called electrogastrography (EGG) was first EGG has shown disturbances of the gastric electric rhythm in described by Alvarez in 1922 (1).
    [Show full text]
  • Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy
    Post-Operative Instruction Sheet Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy Direct Laryngoscopy: Examination of the voice box or larynx (pronounced “lair-inks”) under general anesthesia. An instrument called a laryngoscope is carefully placed into the mouth and used to visualize the larynx and surrounding structures. Bronchoscopy: Examination of the windpipe below the voice box in the neck and chest under general anesthesia. A long narrow telescope is passed through the larynx and used to carefully inspect the structures of the trachea and bronchi. Esophagoscopy: Examination of the swallowing pipe in the neck and chest under general anesthesia. An instrument called an esophagoscope is passed into the esophagus (just behind the larynx and trachea) and used to visualize the mucus membranes and surrounding structures of the esophagus. Frequently a small biopsy is taken to evaluate for signs of esophageal inflammation (esophagitis). What to Expect: Diagnostic airway endoscopy procedures generally take about 45 minutes to complete. Usually the procedure is well-tolerated and the child is back-to-normal the next day. Mild throat or tongue discomfort may persist for a few days after the procedure and is usually well-controlled with over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin). Warning Signs: Contact the office immediately at (603) 650-4399 if any of the following develop: • Worsening harsh, high-pitched noisy-breathing (stridor) • Labored breathing with chest retractions or flaring of the nostrils • Bluish discoloration of the lips or fingernails (cyanosis) • Persistent fever above 102°F that does not respond to Tylenol or Motrin • Excessive coughing or respiratory distress during feeding • Coughing or throwing up bright red blood • Excessive drowsiness or unresponsiveness Diet: Resume baseline diet (no special postoperative diet restrictions).
    [Show full text]
  • Laryngeal Endoscopy (Rigid, Flexible, and Stroboscopy)
    Laryngeal Endoscopy (Rigid, Flexible, and Stroboscopy) Visualization of the larynx can be performed via several different methods. Special tools are required for laryngeal evaluation. Mirror laryngoscopy (1) o While the patient’s tongue is protruded, a mirror is placed in the posterior oropharynx with gentle pressure on the soft palate while light is reflected caudally into the larynx. o Mirror laryngoscopy can be challenging for both the examiner and the patient, has limited magnification, and may require topical anesthesia. o Mirror laryngoscopy provides the most accurate color representation of laryngeal and pharyngeal tissue because there is no light or digital distortion. Flexible laryngoscopy (2) o A flexible laryngoscope is placed into the nasal cavity, through the naso- and oropharynx and positioned cephalad to the larynx for a full laryngeal assessment. o Nasal anesthesia (lidocaine) and/or nasal decongestants (oxymetazoline/phenylephrine) may be applied to the nose for the purpose of improving patient comfort and tolerance o Supplemental procedures such as dynamic voice assessment (comprehensive laryngeal movement evaluation), functional endoscopic evaluation of swallowing (+/- sensory testing), and other laryngeal procedures (ex. injections, laser surgery, biopsies) can be performed during flexible laryngoscopy. o Flexible laryngoscopy is ideal for evaluating vocal fold weakness, real-time/unencumbered evaluation of task-specific abnormalities (ex. my voice is problematic when I do this), and assessing the intensity of glottal attack. Rigid Laryngoscopy (3) o Rigid laryngoscopy is performed by placing a rigid 70- or 90-degree telescope into the oropharynx during tongue protrusion. o Sometimes, oropharyngeal and/or tongue application of anesthesia (ex. lidocaine, cetacaine) can be helpful for patient tolerance.
    [Show full text]
  • ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding
    nature publishing group PRACTICE GUIDELINES 1265 CME ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding L a u r e n B . G e r s o n , M D , M S c , F A C G1 , J e ff L. Fidler , MD 2 , D a v i d R . C a v e , M D , P h D , F A C G 3 a n d J o n a t h a n A . L e i g h t o n , M D , F A C G 4 Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5–10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identifi ed in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classifi cation of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identifi ed anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a fi rst-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required.
    [Show full text]
  • Clinical Utility of Electrogastrography and the Water Load Test in Patients with Upper Gastrointestinal Symptoms
    J. Smooth Muscle Res. (2006) 42 (5): 149–157 149 Original Clinical utility of electrogastrography and the water load test in patients with upper gastrointestinal symptoms Chien-Lin CHEN1, Chi-Tan HU1, Hsien-Hong LIN1 and Chih-Hsun YI1 1Department of Medicine, Buddhist Tzu Chi General Hospital and University School of Medicine, 707, Sec. 3, Chung-Yang Rd., Hualien 970, Taiwan Received July 31, 2006; Accepted September 14, 2006 Abstract We assessed gastric myoelectric functioning in patients with various gastrointestinal symptoms and to determine the utility of electrogastrography in differentiating specific disease entities. Electrogastrography with a water load was performed in 101 patients with reflux disease, 55 patients with active gastric ulcer, 59 patients with functional dyspepsia, and 30 controls. Upper gastrointestinal symptoms were assessed in each patient. Electrogastrography was abnormal in 41 (40.6%) patients with reflux disease, 31 (56.4%) patients with active gastric ulcer, and 26 (44.1%) patients with functional dyspepsia (P=NS). Water load tolerance was greater in controls than any patient group (all P<0.05). Symptoms predicted abnormal electrogastrography in reflux patents with satiety (OR=2.9; P<0.05) and in dyspeptic patients with nausea (OR=3.1; P<0.05). Although electrogastrography is helpful in differentiating subgroups of patients with nausea or satiety, it cannot directly differentiate disease states such as reflux disease, gastric ulcer, and functional dyspepsia. Key words: electrogastrography, gastric myoelectrical activity, gastrointestinal symptom Introduction Functional dyspepsia (FD) is common and is often defined as episodic or persistent upper abdominal symptoms related to eating (Barbara et al., 1989). Dyspeptic symptoms include vague epigastric or periumbilical discomfort, early satiety, postprandial fullness, bloating, regurgitation, nausea, and vomiting (Drossman, 1999).
    [Show full text]
  • Endoscopic Technique for Diag- Nostic Investigations and Therapeutic Interventions of Small Bowel Pathology
    ENDOSCOPY: OPENING NEW EYES, SERIES #3 Andrew K. Roorda, M.D., Series Editor The Evolution of Enteroscopy to Spiral Enteroscopy Disaya Chavalitdhamrong Rome Jutabha The diagnosis and treatment of small bowel diseases has historically proven difficult and challenging for gastroenterologists. Although sonde and push enteroscopy were developed first, the former is time-consuming and uncomfortable and the latter limits examination to the proximal jejunum. Intraoperative enteroscopy, which was once con- sidered the gold standard of enteroscopy, has largely been replaced by newer less inva- sive techniques. Capsule endoscopy provides a thorough examination of the small bowel but it does not allow for therapeutic interventions. Balloon-assisted enteroscopy was developed for complete examination of the small bowel and therapeutic interven- tions. Spiral enteroscopy has emerged as a viable alternative to balloon-assisted enteroscopy. It is a safe, effective, and relatively rapid endoscopic technique for diag- nostic investigations and therapeutic interventions of small bowel pathology. This arti- cle reviews the milestone technologies of enteroscopy highlighting the latest developed spiral enteroscopy. INTRODUCTION form endoscopic treatments. With the development of ndoscopic diagnosis and treatment of small bowel balloon-assisted enteroscopy and most recently, spiral conditions is a challenging area for gastroenterol- enteroscopy, endoscopic diagnosis and treatment of Eogists. Until recently, it was not possible to access the entire small intestine are now feasible without most of the small bowel using endoscopic techniques operative intervention. As indications expand and without concomitant surgery. Capsule endoscopy and caseloads grow, it is important for gastroenterologists balloon-assisted enteroscopy thus represent decisive to know how these procedures are done and to be breakthroughs in this field.
    [Show full text]
  • Gastroparesis and Dumping Syndrome: Current Concepts and Management
    Journal of Clinical Medicine Review Gastroparesis and Dumping Syndrome: Current Concepts and Management Stephan R. Vavricka 1,2,* and Thomas Greuter 2 1 Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland 2 Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland * Correspondence: [email protected] Received: 21 June 2019; Accepted: 23 July 2019; Published: 29 July 2019 Abstract: Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. Although gastroparesis results from delayed gastric emptying and dumping syndrome from accelerated emptying of the stomach, the two entities share several similarities among which are an underestimated prevalence, considerable impairment of quality of life, the need for a multidisciplinary team setting, and a step-up treatment approach. In the following review, we will present an overview of the most important clinical aspects of gastroparesis and dumping syndrome including epidemiology, pathophysiology, presentation, and diagnostics. Finally, we highlight promising therapeutic options that might be available in the future. Keywords: gastroparesis; dumping syndrome; pathophysiology; clinical presentation; treatment 1. Introduction Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. While gastroparesis results from significantly delayed gastric emptying, dumping syndrome is a consequence of increased flux of food into the small bowel [1,2]. The two entities share several important similarities: (i) gastroparesis and dumping syndrome are frequent, but also frequently overlooked; (ii) they affect patient’s quality of life considerably due to possibly debilitating symptoms; (iii) patients should be taken care of within a multidisciplinary team setting; and (iv) treatment should follow a step-up approach from dietary modifications and patient education to pharmacological interventions and, finally, surgical procedures and/or enteral feeding.
    [Show full text]
  • Myoelectric Activity of the Stomach Gastroelectromyography and Electrogastrography
    MYOELECTRIC ACTIVITY OF THE STOMACH GASTROELECTROMYOGRAPHY AND ELECTROGASTROGRAPHY PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR IN DE GENEESKUNDE AAN DE ERASMUS UNIVERSITEIT ROTTERDAM OP GEZAG VAN DE RECTOR MAGNIFICUS PROF. DR. J. SPERNA WEILAND EN VOLGENS BESLUIT VAN HET COLLEGE VAN DEKANEN DE OPENBARE VERDEDIGING ZAL PLAATS VINDEN OP WOENSDAG 4 JUNI 1980 DES NAMIDDAGS TE 4.15 UUR DOOR ANDREAS JOHANNES PETRUS MARIA SMOUT GEBOREN TE AMSTERDAM DELFT UNIVERSITY PRESS I 1980 PROMOTOREN . : PROF. DR. G. VAN DEN BRINK PROF. DR. D.L WESTBROEK CO-REFERENTEN: PROF. DR. J.TH.F. BOELES PROF. DR. M. FRENKEL aan Anja en Danielle VOORWOORO Aan het tot stand komen van dit proefschrift hebben zeer velen in belangrijke mate bijgedragen. Allen ben ik zeer erkentel ijk. In het bijzonder wil ik alle (vaste en tijdel ijke) medewerkers van de afdel ing Medische Technologie der Erasmus Universiteit danken voor de uitermate plezie­ rige en vruchtbare samenwerking. VI CONTENTS page 1. INTRODUCTION AND OBJECTIVES OF THE STUDIES 2. ANATOMY OF THE STOMACH 3 2.1 Macroscopic anatomy 3 2.2 Microscopic anatomy of intercellular contacts between gastric smooth muscle cells 5 3. INTRACELLULAR ELECTRICAL ACTIVITY OF GASTRIC SMOOTH MUSCLE (LITERATURE SURVEY) 9 3.1 Introduction 9 3.2 Frequencies of action potentials in gastric muscle strips 10 3.3 Configurations of action potentials of gastric muscle 10 3. 3.1 Resting membrane potential 11 3.3.2 Depolarization phase 11 3.3.3 Plateau phase 12 3.3.4 Repolarization phase 15 3.4 Intracellular electrical activity of fundic smooth muscle cells 15 4.
    [Show full text]
  • Flexible Sigmoidoscopy – Outpatients
    Flexible sigmoidoscopy – Outpatients You have been referred by your doctor to have a flexible sigmoidoscopy. his information booklet has been written to explain the procedure. This will help you to make an informed decision before consenting to the procedure. If you are unable to attend your appointment please inform us as soon as possible. Please ensure you read this booklet and the enclosed consent form thoroughly. Please also complete the enclosed health questionnaire. You may be contacted by an endoscopy trained nurse before your procedure to go through the admission process and answer any queries you may have. If you are not contacted please come to your appointment at the time stated in your letter. Please note your appointment time is your arrival time on the unit and not the time of your procedure. If you have any mobility issues or if there is a possibility you could be pregnant, please contact the appointment staff on 01284 713551 Please remember there will be other patients in the unit who may arrive after you but are taken in for their procedure before you, this is for medical reasons or they are seeing a different doctor. Due to limited space available and to maintain other patients’ privacy and dignity, we only allow patients (and carers) through to the ward area. Relatives/ escorts will be contacted once you are ready for collection. The Endoscopy Unit endeavours to offer single sex facilities, and we aim to make you stay as comfortable and stress free as possible. Source: Endoscopy Reference No: 5035-14 Issue date: 8/1/21 Review date: 8/1/24 Page 1 of 11 Medication If you are taking WARFARIN, CLOPIDOGREL, RIVAROXABAN or any other anticoagulant (blood thinning medication), please contact the appointment staff on 01284 713551, your GP or anticoagulation nurse, as special arrangements may be necessary.
    [Show full text]
  • SPECIALTY CARE Digestive Health
    SPECIALTY CARE Digestive Health Through our Day Kimball Medical Group A lot of people care about your health. Including us. So if you’re 45 or practices and other associated specialty over and due for a colon screening, you should know that Day Kimball physicians, Day Kimball Healthcare has one of the most comprehensive digestive health programs around. provides you access to expert specialized care for virtually every body system Gastroenterology deals with the function, diseases and disorders of and condition, within an integrated and the digestive system, including the esophagus, stomach, pancreas, gall coordinated approach. bladder, bile ducts, liver, small intestine, colon (or large intestine), and rectum. Most everyone will need specialized care at some point in life. It’s good to know Physician Consultations that when that time comes you’ll have Consults for advanced treatment of digestive and liver disorders are access to physicians and facilities focused available through our associated board-certified gastroenterologists solely on providing you with top-notch from Connecticut GI. A referral from your primary care practitioner specialized care, close to home. (PCP) is required. Day Kimball Healthcare offers integrated, comprehensive care Endoscopy Services With our state-of-the-art Doris E. Madeira Endoscopy Suite at Day close to home. To learn more Kimball Hospital and the services of our associated gastroenterologists about all of our specialty from Connecticut GI, we are able to offer comprehensive screening, medical services
    [Show full text]