Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal.

PURPOSE: This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. METHODS: This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. RESULTS: Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. CONCLUSION: Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.

Electron tomography combining ESEM and STEM: a new 3D imaging technique.

This paper presents the development and the application of a new electron tomography technique based on STEM (Scanning Transmission Electron Microscopy) configuration in ESEM (Environmental Scanning Electron Microscopy). This combination provides a new approach for the characterization of the 3D structure of materials, as it optimizes a compromise between the resolution level of a few tens of nm and the large tomogram size due to the high thickness of transparency. The method is well adapted for non-conductive samples, and exhibits good contrast even for materials with low atomic number. The paper describes the development of a dedicated stage for this new tomography technique. Taking advantage of the size of the ESEM chamber, the range of tilt angles is not limited by the space around the sample. The performance of this device is illustrated through the three-dimensional characterization of samples issued from materials science and chosen to illustrate the results in resolution, contrast and thickness.

Improvements for imaging ceramics sintering in situ in ESEM.

Sintering of green samples of alumina produced by ice-templating was followed in situ in an environmental scanning electron microscope (ESEM) up to temperatures as high as 1375°C. These alumina samples with well-defined architectures are of great interest in the field of materials science due to their high specific strength (especially in compression), low density and adaptable porosity. For the present study, they also have the advantage to exhibit an important topography, inducing interesting contrast when imaged in an ESEM. Improvements of the imaging conditions in the ESEM were essential to really follow the sintering process involving formation of necks between grains or shift of the centre of grains. This paper describes the improvements made and the results observed on the sintering process of alumina green samples processed by ice-templating.

Characterization of precipitates size distribution: validation of low-voltage STEM.

The size distribution of second phase precipitates is frequently determined using conventional transmission electron microscopy (CTEM). However, other techniques, which present different advantages, can also be used for this purpose. In this paper, we focus on high angle annular dark field (HAADF) in TEM and scanning TEM (STEM) in scanning electron microscopy (SEM) imaging modes. The mentioned techniques will be first described, then compared to more conventional ones for the measurement of carbides size distribution in two FeCV and FeCVNb model alloys. This comparative study shows that STEM in SEM, a technique much easier to undertake compared to TEM, is perfectly adapted for size distribution measurements of second phase particles, with sizes ranging between 5 and 200 nm in these systems.

A history of scanning electron microscopy developments: towards "wet-STEM" imaging.

A recently developed imaging mode called "wet-STEM" and new developments in environmental scanning electron microscopy (ESEM) allows the observation of nano-objects suspended in a liquid phase, with a few manometers resolution and a good signal to noise ratio. The idea behind this technique is simply to perform STEM-in-SEM, that is SEM in transmission mode, in an environmental SEM. The purpose of the present contribution is to highlight the main advances that contributed to development of the wet-STEM technique. Although simple in principle, the wet-STEM imaging mode would have been limited before high brightness electron sources became available, and needed some progresses and improvements in ESEM. This new technique extends the scope of SEM as a high-resolution microscope, relatively cheap and widely available imaging tool, for a wider variety of samples.

Wet STEM: a new development in environmental SEM for imaging nano-objects included in a liquid phase.

Environmental scanning electron microscopy (ESEM) enables wet samples to be observed without potentially damaging sample preparation through the use of partial water vapour pressure in the microscope specimen chamber. However, in the case of latices in colloidal state or microorganisms, samples are not only wet, but made of objects totally submerged in a liquid phase. In this case, under classical ESEM imaging conditions only the top surface of the liquid is imaged, with poor contrast, and possible drifting of objects. The present paper describes experiments using a powerful new Scanning Transmission Electron Microscopy (STEM) imaging system, that allows transmission observations of wet samples in an ESEM. A special device, designed to observe all sorts of objects submerged in a liquid under annular dark-field imaging conditions, is described. Specific features of the device enable to avoid drifting of floating objects which occurs in the case of a large amount of water, thus allowing slow-scan high-definition imaging of particles with a diameter down to few tens of nm. The large potential applications of this new technique are then illustrated, including the imaging of different nano-objects in water. The particular case of grafted latex particles is discussed, showing that it is possible to observe details on their surface when submerged in water. All the examples demonstrate that images acquired in wet STEM mode show particularly good resolution and contrast, without adding enhancing contrast objects, and without staining.