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A simple, rapid technique for producing color prints from 35-mm transparencies
0016-5107/81/2702-0069$02.00/0 GASTROINTESTINAL ENDOSCOPY Copyright © 1981 by the American Society for Gastrointestinal Endoscopy
Case Reports & Technical Notes A simple, rapid technique for producing color prints from 35-mm transparencies Theodore Cohen, MD
For the most part endoscopic photography is accomplished utilizing 35-mm transparencies. This is an excellent technique for teaching purposes or for building a permanent collection. However, it has the disadvantage of providing only a single graphic record which usually remains with the endoscopist. Although a processed slide may be obtained from most commercial photographic laboratories within 1 to 3 days, the return time for receiving a print made from a transparency averages 7 to 10 days or more depending upon intervening holidays, weekends, etc. The advantages of rapidly obtaining a print are to document the endoscopic findings on a hospitalized patient's chart, to accompany a written report to the referring physician, and, in those instances in which a patient is to be transferred, to provide a picture of the endoscopic pathology. Color prints from transparencies can be produced within a few minutes without the arduous preparation of fresh solutions. A relatively small financial investment and a minimum of photographic expertise are all that is required if a room which can be completely blacked out is available. The dark room in the x-ray area of an office or hospital is ideal. At home, a room in the basement, a large closet, or a bathroom are good alternatives.
MATERIALS
more accurate, the verbal counting off of seconds has proved to be sufficiently accu rate.
TECHNIQUE The slide is placed into the enlarger in a reversed position (otherwise a mirror image print will result). All the room lights are turned off and the image is projected onto a white piece of paper which has been cut to fit into the opening of that portion of the film holder which covers the film to be exposed. Two different size circles or squares can be drawn on the white paper to serve as guides for determining the size of the image to be made. If a particular transparency is slightly blurred, a smaller image should be made in order to minimize the lack of sharpness. Raising and lowering the enlarger will alter the size of the image. With the film holder tucked in the corner, the entire easel is moved in order to center the image to be printed. Focusing is accomplished using the naked eye with the lens opened to its maximum. Following this, the lens is closed to its smallest aperture. It should be remembered that the larger the F number on the lens barrel, the smaller the lens opening and consequently the less light emitted. The reverse applies for the larger F number. Moving a single number on the lens doubles or halves (depending upon the direction) the amount of light coming through the lens. The enlarger light is then turned off, the white focusing paper removed, and in total darkness the dark shield is pulled open entirely as determined by feel. If the film holder is moved accidentally, it can be repositioned exactly by feeling for the corner of the easel.
1. An enlarger for 35-mm transparencies. Expensive, sophisticated models are unnecessary and a satisfactory piece of equipment can be purchased for under $100. 2. The Polaroid Land pack film holder for series 100 film. The cost is approximately $65. 3. Type 108 or 668 Polaroid film which averages 75~ a print provides a 4% X 3%-inch picture. Either type may be used since the slightly different hues which are obtained are of no significance. Available also are film sheets up to 8 X 10 inches in size. 4. A photographic easel into the corner of which the film holder is placed. The cost is approximately $15. 5. A wristwatch. Although a mechanical timer is Presented before the 2nd International Congress on Colonoscopy and Disease of the Large Bowel, Bal Harbour, Florida, March 1980. From the Departments of Gastroenterology and Medicine of the Booth Memorial Medical Center, Flushing, New York, and the New York University Medical Center, New York, New York.. Reprint requests: Theodore Cohen, MD, 71-40 112th Street, Forest Hills, New York 11375. VOLUME 27, NO.2, 1981
Figure 1. Print obtained from a 35-mm transparency showing a small adenomatous polyp in the descending colon (F22 for 2 seconds). 69
The enlarger light is turned on for an average of 2 to 4 seconds, as determined by counting orally (1-1000, 2-1000, 3-1000, etc.) and then manually shut off. The dark shield is then closed completely and the room lights put on. The picture is easily developed in 60 seconds by following the manufacturer's instructions. Multiple prints, if needed, should be made at this time. Trial and error wi II usually resu It in a very satisfactory print. If the initial print is too dark, a longer period of exposure is needed for the next test print. This is achieved by either keeping the enlarger light on for a few extra seconds or else by opening the lens to the next smallest number. If the picture is too light, less exposure time is required. One can often improve the quality of prints obtained from a poor transparency by
following this procedure. In some instances, a 1-second exposure may still result in too light an image. This can be corrected by screwing a neutral density filter into the bottom of the lens before the picture is to be exposed. This filter decreases the amount of light coming through without affecting color, image, or size. The filters are in series and graded from 1 to 6. The purchase of filters no. 2 and no. 4 will cover most situations. It may be easier to buy a Spiratone (Flushing, NY) variable neutral density filter. The degree of filtration can be adjusted simply by turning the ring which is an integral part of the filter. This eliminates the need for handling multiple filters. After some experience is gained, one is usually able to judge more easily the proper exposure for obtaining an excellent print (Fig. 1).
Endoscopic removal of a granular cell tumor of the esophagus
longitudinal esophageal fold above the lesion contributed to the appearance of a stalk. Biopsies showed unremarkable squamous epithelium with smooth muscle seen in one fragment. The lesion appeared to be freely moveable on a short stalk and we performed transendoscopic resection with a wire snare and electrosurgical unit. Transection of the stalk appeared to require more than the usual amount of current. When the polyp was removed, a O.B-cm diameter burn was noted at the polypectomy site. The patient tolerated the procedure well and had an uneventful subsequent course with no dysphagia. On cut section the polyp revealed a homogeneous, creamy white, moderately firm surface. Microscopically the polyp consisted predominately of large polygonal granular cells covered by a stratified squamous epithelium with slight inflammation (Fig. 3). Follow-up endoscopy at 3 months showed complete healing of the esophagus. No mucosal or submucosal lesions were seen.
Robert S. Sandler, MD David R. Wood, MD Eugene M. Bozymski, MD
Granular cell tumors are rare lesions of neural origin. Since their initial description in 1926 by Abrikossoff, there have been only 22 cases in which the tumor was found in the esophagus. 1 We report the first case in which a granular cell tumor was removed by transendoscopic wire snare. CASE REPORT A 53-year-old woman was referred for evaluation of a 2month history of dysphagia for solid foods and postprandial vomiting. Ten months earlier she was evaluated for epigastric pain at a local hospital. An upper gastrointestinal series revealed tertiary contractions of the distal esophagus and an oral cholecystogram was negative. Her medications on admission included cimetidine, propranolol for hypertension, and aspirin for osteoarthritis. She admitted to moderate alcohol use. Her physical examination was unremarkable except for the presence of occult blood in the stool. Sigmoidoscopy and barium enema examination were normal. An upper gastrointestinal series demonstrated a 2.5-cm diameter polypoid lesion in the distal esophagus (Fig. 1). Esophagoscopy revealed a pinkish tan polypoid lesion 30 cm from the incisors (Fig. 2). The lesion had a firm, rubbery consistency, was covered by normal appearing mucosa, and appeared to be attached by a short stalk. A From the Division of Digcstive Diseases and Nutrition, Department of Medicine, University of North Carolina School of Mcdicine, Chapel Hill, North Carolina. This investigation was supported in part by National Canccr Institute Grant CA 17973. Reprint rcquests: Robert S. Sandler, MD, Division of Digestivc Diseascs and Nutrition, Room 324, Clinical Sciences Building 229H, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27.514.
70
DISCUSSION Granular cell tumors may be found throughout the body but have a predilection for the upper digestive and respiratory tract, with a third of the lesions found in the tongue. 2 - 4 Other common sites include the skin, subcutaneous tissue, and the breast 4 The lesion most commonly occurs in the 3rd to 5th decade 5 Granular cell tumors of the esophagus are more common in women (79%) and are multiple in 25% of cases. Malignant granular cell tumors have been reported but are much less common than the benign variety.6 When the tumors are malignant, they are often slow growing. 6 One should distinguish a multicentric tumor from a malignant tumor with metastases 5 Although these lesions are often termed granular cell myoblastomas, they are thought to be of neural origin. In 1952 Bangle presented evidence based on histologic and histochemical studies that showed that the granular material was derived from degeneration GASTROINTESTINAL ENDOSCOPY
Case Reports & Technical Notes A simple, rapid technique for producing color prints from 35-mm transparencies Theodore Cohen, MD
For the most part endoscopic photography is accomplished utilizing 35-mm transparencies. This is an excellent technique for teaching purposes or for building a permanent collection. However, it has the disadvantage of providing only a single graphic record which usually remains with the endoscopist. Although a processed slide may be obtained from most commercial photographic laboratories within 1 to 3 days, the return time for receiving a print made from a transparency averages 7 to 10 days or more depending upon intervening holidays, weekends, etc. The advantages of rapidly obtaining a print are to document the endoscopic findings on a hospitalized patient's chart, to accompany a written report to the referring physician, and, in those instances in which a patient is to be transferred, to provide a picture of the endoscopic pathology. Color prints from transparencies can be produced within a few minutes without the arduous preparation of fresh solutions. A relatively small financial investment and a minimum of photographic expertise are all that is required if a room which can be completely blacked out is available. The dark room in the x-ray area of an office or hospital is ideal. At home, a room in the basement, a large closet, or a bathroom are good alternatives.
MATERIALS
more accurate, the verbal counting off of seconds has proved to be sufficiently accu rate.
TECHNIQUE The slide is placed into the enlarger in a reversed position (otherwise a mirror image print will result). All the room lights are turned off and the image is projected onto a white piece of paper which has been cut to fit into the opening of that portion of the film holder which covers the film to be exposed. Two different size circles or squares can be drawn on the white paper to serve as guides for determining the size of the image to be made. If a particular transparency is slightly blurred, a smaller image should be made in order to minimize the lack of sharpness. Raising and lowering the enlarger will alter the size of the image. With the film holder tucked in the corner, the entire easel is moved in order to center the image to be printed. Focusing is accomplished using the naked eye with the lens opened to its maximum. Following this, the lens is closed to its smallest aperture. It should be remembered that the larger the F number on the lens barrel, the smaller the lens opening and consequently the less light emitted. The reverse applies for the larger F number. Moving a single number on the lens doubles or halves (depending upon the direction) the amount of light coming through the lens. The enlarger light is then turned off, the white focusing paper removed, and in total darkness the dark shield is pulled open entirely as determined by feel. If the film holder is moved accidentally, it can be repositioned exactly by feeling for the corner of the easel.
1. An enlarger for 35-mm transparencies. Expensive, sophisticated models are unnecessary and a satisfactory piece of equipment can be purchased for under $100. 2. The Polaroid Land pack film holder for series 100 film. The cost is approximately $65. 3. Type 108 or 668 Polaroid film which averages 75~ a print provides a 4% X 3%-inch picture. Either type may be used since the slightly different hues which are obtained are of no significance. Available also are film sheets up to 8 X 10 inches in size. 4. A photographic easel into the corner of which the film holder is placed. The cost is approximately $15. 5. A wristwatch. Although a mechanical timer is Presented before the 2nd International Congress on Colonoscopy and Disease of the Large Bowel, Bal Harbour, Florida, March 1980. From the Departments of Gastroenterology and Medicine of the Booth Memorial Medical Center, Flushing, New York, and the New York University Medical Center, New York, New York.. Reprint requests: Theodore Cohen, MD, 71-40 112th Street, Forest Hills, New York 11375. VOLUME 27, NO.2, 1981
Figure 1. Print obtained from a 35-mm transparency showing a small adenomatous polyp in the descending colon (F22 for 2 seconds). 69
The enlarger light is turned on for an average of 2 to 4 seconds, as determined by counting orally (1-1000, 2-1000, 3-1000, etc.) and then manually shut off. The dark shield is then closed completely and the room lights put on. The picture is easily developed in 60 seconds by following the manufacturer's instructions. Multiple prints, if needed, should be made at this time. Trial and error wi II usually resu It in a very satisfactory print. If the initial print is too dark, a longer period of exposure is needed for the next test print. This is achieved by either keeping the enlarger light on for a few extra seconds or else by opening the lens to the next smallest number. If the picture is too light, less exposure time is required. One can often improve the quality of prints obtained from a poor transparency by
following this procedure. In some instances, a 1-second exposure may still result in too light an image. This can be corrected by screwing a neutral density filter into the bottom of the lens before the picture is to be exposed. This filter decreases the amount of light coming through without affecting color, image, or size. The filters are in series and graded from 1 to 6. The purchase of filters no. 2 and no. 4 will cover most situations. It may be easier to buy a Spiratone (Flushing, NY) variable neutral density filter. The degree of filtration can be adjusted simply by turning the ring which is an integral part of the filter. This eliminates the need for handling multiple filters. After some experience is gained, one is usually able to judge more easily the proper exposure for obtaining an excellent print (Fig. 1).
Endoscopic removal of a granular cell tumor of the esophagus
longitudinal esophageal fold above the lesion contributed to the appearance of a stalk. Biopsies showed unremarkable squamous epithelium with smooth muscle seen in one fragment. The lesion appeared to be freely moveable on a short stalk and we performed transendoscopic resection with a wire snare and electrosurgical unit. Transection of the stalk appeared to require more than the usual amount of current. When the polyp was removed, a O.B-cm diameter burn was noted at the polypectomy site. The patient tolerated the procedure well and had an uneventful subsequent course with no dysphagia. On cut section the polyp revealed a homogeneous, creamy white, moderately firm surface. Microscopically the polyp consisted predominately of large polygonal granular cells covered by a stratified squamous epithelium with slight inflammation (Fig. 3). Follow-up endoscopy at 3 months showed complete healing of the esophagus. No mucosal or submucosal lesions were seen.
Robert S. Sandler, MD David R. Wood, MD Eugene M. Bozymski, MD
Granular cell tumors are rare lesions of neural origin. Since their initial description in 1926 by Abrikossoff, there have been only 22 cases in which the tumor was found in the esophagus. 1 We report the first case in which a granular cell tumor was removed by transendoscopic wire snare. CASE REPORT A 53-year-old woman was referred for evaluation of a 2month history of dysphagia for solid foods and postprandial vomiting. Ten months earlier she was evaluated for epigastric pain at a local hospital. An upper gastrointestinal series revealed tertiary contractions of the distal esophagus and an oral cholecystogram was negative. Her medications on admission included cimetidine, propranolol for hypertension, and aspirin for osteoarthritis. She admitted to moderate alcohol use. Her physical examination was unremarkable except for the presence of occult blood in the stool. Sigmoidoscopy and barium enema examination were normal. An upper gastrointestinal series demonstrated a 2.5-cm diameter polypoid lesion in the distal esophagus (Fig. 1). Esophagoscopy revealed a pinkish tan polypoid lesion 30 cm from the incisors (Fig. 2). The lesion had a firm, rubbery consistency, was covered by normal appearing mucosa, and appeared to be attached by a short stalk. A From the Division of Digcstive Diseases and Nutrition, Department of Medicine, University of North Carolina School of Mcdicine, Chapel Hill, North Carolina. This investigation was supported in part by National Canccr Institute Grant CA 17973. Reprint rcquests: Robert S. Sandler, MD, Division of Digestivc Diseascs and Nutrition, Room 324, Clinical Sciences Building 229H, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27.514.
70
DISCUSSION Granular cell tumors may be found throughout the body but have a predilection for the upper digestive and respiratory tract, with a third of the lesions found in the tongue. 2 - 4 Other common sites include the skin, subcutaneous tissue, and the breast 4 The lesion most commonly occurs in the 3rd to 5th decade 5 Granular cell tumors of the esophagus are more common in women (79%) and are multiple in 25% of cases. Malignant granular cell tumors have been reported but are much less common than the benign variety.6 When the tumors are malignant, they are often slow growing. 6 One should distinguish a multicentric tumor from a malignant tumor with metastases 5 Although these lesions are often termed granular cell myoblastomas, they are thought to be of neural origin. In 1952 Bangle presented evidence based on histologic and histochemical studies that showed that the granular material was derived from degeneration GASTROINTESTINAL ENDOSCOPY