This is a service that benefits patients greatly. The number of untrained or unqualified physicians using the 'scopes is increasing. The mortality and morbidity is definitely going up, at least in our area. I think the time has come for the A/S/G/E to insist on certain qualifications and proficiency ofthe physician doing endoscopy and probably relate this to local medical societies andlor hospitals. Tarik Elibol, M.D. 350 Alberta Drive Buffalo, New York 14226
Eight movies can also be made by simply pressing the Super Eight camera against the endoscope.
Acknowledgement: To Mrs. B. B. Lesesne, Sr., whose gift of a Polaroid camera to take pictures of her grandchildren initiated work on this technique. Henry R. Lesesne, M. D. Division of Gastroenterology N. C. Memorial Hospital Chapel Hill, N. C. 27514
Inexpensive color polaroid photography at endoscopy The use of the Polaroid camera at endoscopy has met with good success and offers immediate photographs for use in a number of situations (Gastroenterology 62: 895, 1972). The Polaroid cameras previously developed for attachment to most endoscopes are expensive or are difficult to assemble. A new technique has been developed for taking Polaroid endoscopic photographs using the inexpensive Polaroid Land cameras, Models 340, 350, 440 and 450. This technique was developed using the Olympus EF Fiberoptic esophagogastroscope with the Cold Light Source, Model CLE, but it can be adapted to other endoscopes.
Several adjustments are made to the Polaroid camera (Figure l,a). Thefilm speed dial is set on 75 (A); the light selector knob is set on "bright sun or dull day" (B); the electric eye is completely covered with black paper and tape so that the photographer can control the shutter opening time (C); and standard Polaroid Colorpack 108, ASA 75 film is used. The endoscope light source is set on its highest setting and the endoscope is set on infinity (Figure l,b). This will be in focus for the Polaroid camera. When taking the photograph, the lesion is first centered in the viewing field, and the patient is asked to hold his breath. Then, as shown in Figure Ic, the camera is pressed firmly against the endoscope and the shutter release button is pressed down for a count of "one thousand and one" and quickly released. The photograph can then be developed when convenient. Good quality photographs have been obtained in twothirds ofcases. Several factors must be considered to obtain good photographs. The lesion is not directly visualized when the photograph is taken. Therefore, the technique should be performed in less than 2 seconds. Excessive movement (e.g., heart pulsation) and excessive light reflection (especially in the esophagus) require a fast shutter opening and closure to reduce overexposure. Finally, lesions more than 6 cm from the tip of the endoscope do not photograph well. Although the use ofless expensive models of the Polaroid Land camera has not been reported, they may be adaptable to this technique and further reduce the expense. Super
Figure l.Adaptation ofthe Polaroid Land Camera to endoscopic photography. GASTROINTESTINAL ENDOSCOPY