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William N Sokol - One of the best experts on this subject based on the ideXlab platform.
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anaphylaxis following cystoscopy caused by cidex opa ortho phthalaldehyde cold sterilization solution
The Journal of Allergy and Clinical Immunology, 2004Co-Authors: William N SokolAbstract:Abstract Background Cidex®-OPA is a high level disinfectant commonly used for processing heat sensitive medical devices. Objective We report 4 patients who experienced 9 episodes of anaphylaxis following cystoscopy after a urology practice switched from using CIDEX® to CIDEX®-OPA for sterilizing their Cystoscopes. Methods Allergic evaluations consisted of: skin testing to saline, histamine, lidocaine, and latex, Ciprofloxacin, Macrodantin, Cidex® and Cidex®-OPA. Total IgE and latex-specific IgE. Findings The 4 patients were evaluated after (3) had experienced two episodes of anaphylaxis and (1) three episodes following outpatient cystoscopy for ongoing evaluation of bladder cancer. Skin testing of subjects to Lidocaine, latex, Ciprofloxacin and Macrodantin, and specific IgE to latex were negative. Skin testing to Cidex® and Cidex®-OPA were performed on 5 "volunteers" and all tests were negative. Skin testing to Cidex® on the four patients were also negative. However, skin testing to Cidex®-OPA resulted an immediate wheal and flare reaction in all 4 patients within 20 minutes (avg. wheal 24.2 mm.) and late reaction between 6 and 24 hours (avg. induration 56.3 mm.). Subsequent to the testing, one of the patients returned for repeat cystoscopy but Cidex® was not used to sterilize the cystosope. The patient tolerated the procedure without any allergic manifestations. Conclusion Cidex®-OPA (ortho-phthaldahyde) solution should be considered as a cause of anaphylactic/allergic reactions following cystoscopy and possibly instrumentation with other medical devices.
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Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy.
The Journal of allergy and clinical immunology, 2004Co-Authors: William N SokolAbstract:Abstract Background Ortho-phthalaldehyde (OPA) is a high-level disinfectant commonly used for processing heat-sensitive medical devices. Objective We report 4 patients who experienced 9 episodes of anaphylaxis following cystoscopy after a urology practice switched from using Cidex (glutaraldehyde [GTA]) to OPA for disinfecting their Cystoscopes. Methods Allergic evaluations consisted of: skin testing to saline, histamine, glycerin, lidocaine, latex, GTA, and OPA and blood tests for total immunoglobulin E (IgE) and latex specific IgE. Findings The 4 patients were evaluated after 3 of them had experienced 2 episodes of anaphylaxis and one of them 3 episodes following outpatient cystoscopy for ongoing evaluation of bladder cancer. Skin testing of subjects and controls to lidocaine, latex, latex specific IgE, and GTA was negative. Skin testing to OPA resulted in immediate wheal and flare reactions in all 4 patients within 20 minutes and late reactions at 24 hours but negative reactions in controls. Subsequent to the testing, 3 of the patients returned for repeat cystoscopy in which GTA but not OPA was used to disinfect the Cystoscopes and tolerated the procedure. Conclusions OPA solution should be considered a cause of anaphylactic/allergic reactions following cystoscopy and possibly following instrumentation with other medical devices disinfected by this material.
Miguel Srougi - One of the best experts on this subject based on the ideXlab platform.
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combined vaginoscopy cystoscopy a novel simultaneous approach improving vesicovaginal fistula evaluation
The Journal of Urology, 2003Co-Authors: Cassio Andreoni, Homero Bruschini, Jose Carlos Truzzi, Rogerio Simonetti, Miguel SrougiAbstract:ABSTRACTPurpose: Using a device that permits simultaneous viewing on the same display (picture in picture) of 2 images we performed combined vaginoscopy-cystoscopy (CVC) during evaluation for vesicovaginal fistula as a means of better visualization, allowing more precise identification and better preoperative planning.Materials and Methods: A regular Cystoscope and a 10 mm 0-degree laparoscope were used. Each was attached to a different microcamera and light source. The cameras were hooked to the back of a Twinvideo (Karl Storz Endoscopy, Tuttlingen, Germany), allowing a wide variety of views combining the 2 images. Cystoscopy was performed as usual and the laparoscope was used for vaginoscopy with a transparent vaginal speculum to maintain the vagina open, while allowing visualization of the vaginal wall. The 2 images were combined in picture in picture, providing confidence during the fistula identification process. Urinary leakage was viewed simultaneously with guide wire passage through the Cystoscope...
Antoine G Van Der Heijden - One of the best experts on this subject based on the ideXlab platform.
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comparison of hexaminolevulinate based flexible and rigid fluorescence cystoscopy with rigid white light cystoscopy in bladder cancer results of a prospective phase ii study
European Urology, 2005Co-Authors: Alfred J Witjes, Paula M J Moonen, Antoine G Van Der HeijdenAbstract:Abstract Introduction and Objective: Several studies have shown that rigid fluorescence cystoscopy (RFC) with hexaminolevulinate (HAL) is superior to standard rigid white light (RWLC) cystoscopy in diagnosing bladder tumours, with a clinically relevant impact on the patient's management. These studies, however, have been done with rigid Cystoscopes. We carried out a study to evaluate whether the technique of fluorescence cystoscopy with HAL was also feasible with a specially designed flexible fluorescence Cystoscope (FFC). Methods: 20 patients with known or suspected bladder cancer were included in a comparative within patient controlled Phase II study. All patients signed informed consent. All patients received 50ml of HAL (Hexvix ® ) 8mM 1h prior to transurethral resection. Using a D-light-C ® system (Storz, Germany), FFC and RFC were performed followed by RWLC. All lesions visible during these three cystoscopies were mapped, taped and resected. Results: In these 20 patients (mean age 71 years (49–89), 3 females) mean HAL instillation time was 81min. Overall 27 histologically confirmed lesions were found in 19 patients. Detection rates in these 19 patients were 14 with FFC, 17 with RFC and 15 with RWLC. Of the 27 lesions 19 were detected with FFC, 23 with RFC and 20 with RWLC. Overall fluorescence intensity using the flexible system was 76% (30–147%) as compared to RFC using a visual analogue score. No side effects were noted which were attributable to HAL. Conclusion: The use of FFC is feasible and seems to be comparable to RWLC and slightly inferior to RFC. Larger studies should determine the role of flexible fluorescence cystoscopy.
Cassio Andreoni - One of the best experts on this subject based on the ideXlab platform.
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combined vaginoscopy cystoscopy a novel simultaneous approach improving vesicovaginal fistula evaluation
The Journal of Urology, 2003Co-Authors: Cassio Andreoni, Homero Bruschini, Jose Carlos Truzzi, Rogerio Simonetti, Miguel SrougiAbstract:ABSTRACTPurpose: Using a device that permits simultaneous viewing on the same display (picture in picture) of 2 images we performed combined vaginoscopy-cystoscopy (CVC) during evaluation for vesicovaginal fistula as a means of better visualization, allowing more precise identification and better preoperative planning.Materials and Methods: A regular Cystoscope and a 10 mm 0-degree laparoscope were used. Each was attached to a different microcamera and light source. The cameras were hooked to the back of a Twinvideo (Karl Storz Endoscopy, Tuttlingen, Germany), allowing a wide variety of views combining the 2 images. Cystoscopy was performed as usual and the laparoscope was used for vaginoscopy with a transparent vaginal speculum to maintain the vagina open, while allowing visualization of the vaginal wall. The 2 images were combined in picture in picture, providing confidence during the fistula identification process. Urinary leakage was viewed simultaneously with guide wire passage through the Cystoscope...
Lovisa Blaise - One of the best experts on this subject based on the ideXlab platform.
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Detection of early bladder carcinoma by fluorescence cystoscopy with Hexvix: optical characterization of a high magnification Cystoscope
'SPIE-Intl Soc Optical Eng', 2011Co-Authors: Lovisa Blaise, Jichlinski Patrice, Weber Bernd-claus, Aymon Daniela, Van Den Bergh Hubert, Wagnières GeorgesAbstract:Fluorescence detection of early superficial bladder cancer has been well established over the last years. This technique exploits the selective production and accumulation within cancerous tissues of photoactive porphyrins (PaP), mainly protoporphyrin IX (PpIX), after the instillation of hexaminolevulinic acid (Hexvix (R)) in the bladder. Although the selective production of PpIX and the sensitivity of this procedure are outstanding, its specificity is still limited by a relatively important proportion of false positive (FP) lesions. Cancerization process often combines with changes in vascular architecture. It is likely that the visualization of these modifications should allow us to differentiate false and true positive (TP). Therefore, our current research focuses on the characterization of positive sites by high magnification (HM) cystoscopy. This new method is investigated by our group to reduce the number of biopsies. In this study, we are using a dedicated rigid Cystoscope, allowing conventional magnification during "macroscopic" white light and fluorescence observation, as well as image acquisition with HM when the endoscope is in contact with the tissue. This is realized by an optical setup directly integrated in the Cystoscope. We describe here an off-clinics calibration procedure that will allow us to assess the vessel architecture and size once we use this optics to observe the bladder mucosa
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Bladder cancer detection by fluorescence imaging with Hexvix®: Analysis and processing of images obtained during high magnification cystoscopy
'SPIE-Intl Soc Optical Eng', 2011Co-Authors: Lovisa Blaise, Van Den Bergh Hubert, Jichlinski P., Aymon D., Weber B.-c., Wagnières GeorgesAbstract:Fluorescence cystoscopy has been recently acknowledged as a useful method to detect early superficial bladder cancer, even flat lesions. After the instillation of hexaminolevulinic acid (Hexvix®) in the bladder for about an hour, photoactivable porphyrins (PaP), mainly protoporphyrin IX (PpIX) accumulate in the cancerous cells. Although we observe a selective production of PpIX and an outstanding sensitivity of this method, false positive (FP) lesions negatively impact its specificity. Carcinogenesis often combines with angiogenesis, and thus changes in vascular architecture. Therefore, the visualization of the vascular modifications on the fluorescence positive sites is likely to differentiate false and true positive (TP). New methods including high magnification (HM) cystoscopy are being investigated by our group, and will yield a reduced number of biopsies and a better characterization of the fluorescence positive sites. In this study, we are using a dedicated rigid Cystoscope, allowing conventional magnification during "macroscopic" observation, as well as image acquisition with HM when the endoscope is in contact with the tissue. Each observed site is biopsied and described by histopathological analysis. The vascular organization (tortuosity, vascular loops, vascular area and diameter) of the fluorescence positive sites was characterized in parallel with an in situ visual grading and a dedicated software procedure. We describe here a simple image processing prototype that classifies the HM images into two classes, according to their pixel distributions. For that purpose, we developed an algorithm in the image spatial and frequency domain, so that the vascular architecture could be described objectively and quantitatively. © 2009 Copyright SPIE - The International Society for Optical Engineering
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High-magnification vascular imaging to reject false-positive sites in situ during Hexvix® fluorescence cystoscopy
'SPIE-Intl Soc Optical Eng', 2010Co-Authors: Lovisa Blaise, Jichlinski Patrice, Weber Bernd-claus, Aymon Daniela, Van Den Bergh Hubert, Wagnières GeorgesAbstract:Fluorescence imaging for detection of non-muscle-invasive bladder cancer is based on the selective production and accumulation of fluorescing porphyrins-mainly, protoporphyrin IX-in cancerous tissues after the instillation of Hexvix®. Although the sensitivity of this procedure is very good, its specificity is somewhat limited due to fluorescence false-positive sites. Consequently, magnification cystoscopy has been investigated in order to discriminate false from true fluorescence positive findings. Both white-light and fluorescence modes are possible with the magnification Cystoscope, allowing observation of the bladder wall with magnification ranging between 30× for standard observation and 650×. The optical zooming setup allows adjusting the magnification continuously in situ. In the high-magnification (HM) regime, the smallest diameter of the field of view is 600 microns and the resolution is 2.5 microns when in contact with the bladder wall. With this Cystoscope, we characterized the superficial vascularization of the fluorescing sites in order to discriminate cancerous from noncancerous tissues. This procedure allowed us to establish a classification based on observed vascular patterns. Seventy-two patients subject to Hexvix® fluorescence cystoscopy were included in the study. Comparison of HM cystoscopy classification with histopathology results confirmed 32/33 (97%) cancerous biopsies and rejected 17/20 (85%) noncancerous lesions
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High-magnification vascular imaging to reject false-positive sites in situ during Hexvix® fluorescence cystoscopy
'SPIE-Intl Soc Optical Eng', 2010Co-Authors: Lovisa Blaise, Jichlinski Patrice, Weber Bernd-claus, Aymon Daniela, Van Den Bergh Hubert, Wagnières GeorgesAbstract:Fluorescence imaging for detection of non-muscle-invasive bladder cancer is based on the selective production and accumulation of fluorescing porphyrins-mainly, protoporphyrin IX-in cancerous tissues after the instillation of Hexvix (R). Although the sensitivity of this procedure is very good, its specificity is somewhat limited due to fluorescence false-positive sites. Consequently, magnification cystoscopy has been investigated in order to discriminate false from true fluorescence positive findings. Both white-light and fluorescence modes are possible with the magnification Cystoscope, allowing observation of the bladder wall with magnification ranging between 30 X for standard observation and 650 X. The optical zooming setup allows adjusting the magnification continuously in situ. In the high-magnification (HM) regime, the smallest diameter of the field of view is 600 microns and the resolution is 2.5 microns when in contact with the bladder wall. With this Cystoscope, we characterized the superficial vascularization of the fluorescing sites in order to discriminate cancerous from noncancerous tissues. This procedure allowed us to establish a classification based on observed vascular patterns. Seventy-two patients subject to Hexvix (R) fluorescence cystoscopy were included in the study. Comparison of HM cystoscopy classification with histopathology results confirmed 32/33 (97%) cancerous biopsies and rejected 17/20 (85%) noncancerous lesions. c 2010 Society of Photo-Optical Instrumentation Engineers. [DOI: 10.1117/1.3484257
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Endoscopic Fluorescence Imaging:Spectral Optimization and in vivo Characterization of Positive Sites by Magnifying Vascular Imaging
Lausanne EPFL, 2010Co-Authors: Lovisa BlaiseAbstract:Since several decades, the physicians are able to access hollow organs with endoscopic methods, which serve both as diagnostic and surgical means in a wide range of disciplines of the modern medicine (e.g. urology, pneumology, gastroenterology). Unfortunately, white light (WL) endoscopy displays a limited sensitivity to early pre-cancerous lesions. Hence, several endoscopic methods based on fluorescence imaging have been developed to overcome this limitation. Both endogenous and exogenously-induced fluorescence have been investigated, leading to commercial products. Indeed, autofluorescence bronchoscopy, as well as porphyrin-based fluorescence cystoscopy, are now on the market. As a matter of fact, fluorescence-based endoscopic detection methods show very high sensitivity to pre-cancerous lesions, which are often overlooked in WL endoscopy, but they still lack specificity mainly due to the high false-positive rate. Although most of these false positives can easily be rejected under WL observation, tissue abnormalities such as inflammations, hyperplasia, and metaplasia are more difficult to identify, often resulting in supplementary biopsies. Therefore, the purpose of this thesis is to study novel, fast, and convenient method to characterize fluorescence positive spots in situ during fluorescence endoscopy and, more generally, to optimize the existing endoscopic setup. In this thesis, several clinical evaluations were conducted either in the tracheo-bronchial tree and the urinary bladder. In the urinary bladder, fluorescence imaging for detection of non-muscle invasive bladder cancer is based on the selective production and accumulation of fluorescing porphyrins, mainly protoporphyrin IX (PpIX), in cancerous tissues after the instillation of Hexvix® during one hour. In this thesis, we adapted a rigid Cystoscope to perform high magnification (HM) cystoscopy in order to discriminate false from true fluorescence positive findings. Both white light and fluorescence modes are possible with the magnification Cystoscope, allowing observation of the bladder wall with magnification ranging between 30× – for standard observation – and 650×. The optical zooming setup allows adjusting the magnification continuously in situ. In the high magnification regime, the smallest diameter of the field of view is 600 microns and the resolution is 2.5 microns, when in contact with the bladder wall. With this HM Cystoscope, we characterized the superficial vascularization of the fluorescing sites in WL (370–700 nm) reflectance imaging in order to discriminate cancerous from non-cancerous tissues. This procedure allowed us to establish a classification based on observed vascular patterns. 72 patients subject to Hexvix® f luorescence cystoscopy were included in the study. Comparison of HM cystoscopy classification with histopathology results confirmed 32/33 (97%) cancerous biopsies, and rejected 17/20 (85%) non-cancerous lesions. No vascular alteration could be observed on the only positive lesion that was negative in HM mode, probably because this sarcomatoid carcinoma was not originating in the bladder mucosa. We established with this study that a magnification ranging between 80× and 100× is an optimal tradeoff to perform both macroscopic PDD and HM reflectance imaging. In order to make this approach more quantitative, different algorithms of image processing (vessel segmentation and skeletonisation, global information extraction) were also implemented in this thesis. In order to better visualize the vessels, we improved their contrast with respect to the background. Since hemoglobin is a very strong absorber, we targeted the two hemoglobin absorption peaks by placing appropriate bandpass filters (blue 405±50 nm, green 550±50 nm) in the light source. HM cystoscopy was then performed sequentially with WL, blue and green illumination. The two latter showed higher vessel-to-background contrast, identifying different layers of vascularization due to the light penetration depth. During fluorescence cystoscopy, we often observed that the images are somehow "blurred" by a greenish screen between endoscope tip and bladder mucosa. Since this effect is enhanced by the urine production, it is more visible with flexible scopes (lower flushing capabilities) and imaging systems that collect only autofluorescence as background. Indeed, when the bladder is not flushed regularly, greenish flows coming out of the ureters can easily be observed. For this reason, it is supposed that some fluorophores contained in the urine are excited by the photodetection excitation light, and appear greenish on the screen. This effect may impair the visualization of the bladder mucosa, and thus cancerous lesions, and lowers sensitivity of the fluorescence cystoscopy. In this thesis, we identified the main metabolites responsible for the liquid fluorescence, and optimized the spectral design accordingly. In the tracheo-bronchial tree, the fluorescence contrast is based on the sharp autofluorescence (AF) decrease on early cancerous lesions in the green spectral region (around 500 nm) and a relatively less important decrease in the red spectral region (> 600 nm) when excited with blue-violet light (around 410 nm). It has been shown over the last years, that this contrast may be attributed to a combined effect of epithelium thickening and higher concentration of hemoglobin in the tissues underneath the (pre-)cancerous lesions. In this thesis, we contributed to the definition of the input design of several new prototypes, that were subsequently tested in the clinical environment. We first showed that narrow-band excitation in the blue-violet could increase the tumor-to-normal spectral contrast in the green spectral region. Then, we quantified the intra- and inter-patient variations in the AF intensities in order to optimize the spectral response of the endoscopic fluorescence imaging system. For this purpose, we developed an endoscopic reference to be placed close to the bronchial mucosa during bronchoscopy. Finally, we evaluated a novel AF bronchoscope with blue-backscattered light on 144 patients. This new device showed increased sensitivity for pre-neoplastic lesions. Similar to what we observed in the bladder, it is likely that developing new imaging capabilities (including vascular imaging) will facilitate discriminating true from false positive in AF bronchoscopy. Here, we demonstrated that this magnification allowed us to resolve vessels with a diameter of about 30 µm. This resolution is likely to be sufficient to identify Shibuya's vascular criteria (loops, meshes, dotted vessels) on AF positive lesions. This criteria allow him to recognize pre-cancerous lesions, and thus can potentially decrease the false-positive rate with our AF imaging system. This magnification was also showed to be better for routine bronchoscopy, since it delivers sharper and more structured images to the operator
