The optimal dose of glucagon: what is enough.
Explore the source record for details and available documents.
Colon↗
Biomedical subjects
D D Maglinte
Publications and source records attributed to D D Maglinte.
Crohn disease of the small intestine: accuracy and relevance of enteroclysis.
The accuracy and clinical relevance of enteroclysis in the evaluation of 138 patients referred for enteroclysis for suspected Crohn disease of the small intestine are reported. The original prospective interpretations of enteroclysis results were assessed after a clinical follow-up period of 2 or more years. With all patients considered, enteroclysis had a sensitivity, specificity, and accuracy of 100%, 98.3%, and 99.3%, respectively, with only one false-positive diagnosis and no false-negative diagnoses. Thirty-one percent (n = 43) of the patients had lesions of early Crohn disease. All patients who required surgery (n = 23) had advanced lesions of the disease, according to enteroclysis criteria. Clinical evidence of Crohn disease did not develop in the 58 patients in whom enteroclysis revealed no abnormality. There were no complications related to the procedure. It is concluded that enteroclysis is an accurate method for diagnosis and exclusion of Crohn disease of the small intestine and provides detailed structural information relevant to appropriate management of the disease.
Adolescent↗
Pelvic prolapse: assessment with evacuation proctography (defecography)
The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.
Adult↗
Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.
A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.
Catheterization↗
Evaluation of the small intestine by enteroclysis for Crohn's disease.
We reviewed the records of 100 consecutive patients referred for enteroclysis by gastroenterologists because of suspected Crohn's disease of the small bowel to assess the clinical utility of the information obtained by this method. More than one-third of the patients in the study group had subtle lesions of early Crohn's disease, all patients who required surgery had severe disease by radiologic criteria, and none of the 34 patients clinically suspected of having Crohn's disease of the small bowel in whom the enteroclysis was normal developed Crohn's disease in two or more years of clinical follow-up. Enteroclysis provides gastroenterologists with accurate and detailed structural information relevant to the appropriate management of the disease and in our hands is a reliable test for excluding Crohn's disease of the small bowel.
Adolescent↗
Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients.
Initial observation and evaluation of patient progress have reduced the number of operative interventions in the management of small intestinal obstruction. The differentiation of simple mechanical from strangulating obstructions has remained difficult. Strangulation is not an invariable component of a closed loop obstruction. We report 27 patients with small bowel obstruction initially managed nonsurgically, in whom enteroclysis 2-8 days after admission demonstrated unsuspected closed loop obstruction. In 25 of the 27 patients, subsequent surgery confirmed the radiologic diagnosis: all the obstructed loops were viable and there was no operative mortality. Our experience suggests that the early performance of enteroclysis should be considered in patients with small bowel obstruction undergoing a trial of nonoperative management.
Adolescent↗
Extracorporeal shock wave lithotripsy of gallbladder stones: a pessimistic view.
Explore the source record for details and available documents.
Aged↗
Oral cholecystography in contemporary gallstone imaging: a review.
The introduction of nonoperative alternatives to elective cholecystectomy in the management of gallstones has resurrected use of oral cholecystography (OCG). This article reviews basic principles involved in the proper performance of OCG and interpretation of the resulting images. The role of OCG in the current management of gallstones is discussed.
Bile↗
Radiologic features of closed loop obstruction: analysis of 25 confirmed cases.
The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.
Adolescent↗
Imaging of the small bowel.
Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. Except for the most proximal jejunal loop, which may occasionally be reached during upper gastrointestinal tract panendoscopy, and the terminal ileum, which can frequently be examined by the colonoscope, the mesenteric small intestine is the only gastrointestinal tract segment for which diagnostic study is not principally dependent upon endoscopic viewing. To the extent that radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied (Maglinte et al., Radiology 1987, 163:297-305). Barium contrast studies and enteroclysis in particular remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed toward specific clinical circumstances that require discrete evaluation of the small-bowel wall and the adjacent tissues and organs.
Humans↗
Factors in the diagnostic delays of small bowel malignancy.
The overall survival from primary malignancies of the small intestine has not changed over more than four decades. This generally is ascribed to delays in establishing the diagnosis and the advanced stage of the disease when treatment is begun. There has been no critical analysis of these delays. To answer these questions, we reviewed the records of all patients diagnosed with small bowel malignancy from 1967 to 1988 at the Methodist Hospital of Indiana. The onset and duration of symptoms, first medical consultation, time of performance of diagnostic procedures and surgery were verified in 77 patients with histologically confirmed small bowel malignancies. The longest delay occurs from the time medical help is sought to the time the diagnosis is made, not from the onset of symptoms to the first medical consultation. The small bowel should always be considered as a source of unexplained, persistent subtle abdominal symptoms.
Adult↗
Barium enema use in Indiana.
All 118 hospital-based radiology departments in Indiana responded to a survey of barium enema (BE) use. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE) for various indications, was similar to that reported for major medical centers around the world. The use of SCBE and DCBE did not differ between small and large hospitals or between hospitals in small versus large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema usually was performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Like major medical centers, there is no consensus regarding many issues in the performance of BE.
Barium Sulfate↗
Radiographic evaluation of suspected small bowel obstruction.
Plain abdominal radiographs and enteroclysis studies were reviewed blindly in 117 consecutive patients undergoing enteroclysis for suspected small bowel obstruction. Plain radiographs were unreliably predictive of the presence of obstruction as determined by enteroclysis and surgery. Among patients with normal or abnormal nonspecific plain radiographs, varying degrees of small bowel obstruction were demonstrated by enteroclysis in 22%. Conversely, of patients with obstruction on plain radiographs, 42% had either normal enteroclysis studies or only minor adhesions. Enteroclysis correctly predicted the presence of obstruction in 100%, the absence of obstruction in 88%, the level (proximal vs distal) of obstruction in 89%, and the etiology of obstruction in 86% of operated patients. Enteroclysis is advocated as the definitive study in patients with clinical uncertainty about the diagnosis of small bowel obstruction.
Diagnosis, Differential↗
The role of the physician in the late diagnosis of primary malignant tumors of the small intestine.
Survival from primary malignancies of the small intestine has not improved during the last four decades. One reason for this is the advanced stage of disease at the time of surgery. In order to determine why diagnosis is made late, we reviewed the records of all patients with small bowel malignancy diagnosed between 1967 and 1988. The time from the onset of symptoms to the first medical contact and the time from medical contact until diagnosis were evaluated in 77 patients. The average delay in diagnosis attributable 1) to the patient failing to report symptoms was less than 2 months, 2) to the physician not ordering the appropriate diagnostic test was 8.2 months, and 3) to the radiologist failing to make the diagnosis was 12 months. Thus, the major delay in diagnosis was after medical help was sought and not from the onset of symptoms to first medical consultation. Physicians must increase their sensitivity to the subtle but persistent symptoms that necessitate a small bowel evaluation.
Adenocarcinoma↗
Barium enema utilization within a defined geographic region: a survey.
All 118 hospital-based radiology departments in Indiana (USA) responded to a survey of barium enema (BE) utilization. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE), for various indications was similar to that reported for major medical centers around the world (RF Thoeni and AR Margulis, Radiology, 167: 7-12, 1988). The use of SCBE and DCBE did not differ between small and large hospitals, or between hospitals in small vs large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema was usually performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Also like major medical centers, there is no consensus regarding many issues in the performance of BE.
Barium↗
Glucagon: common untoward reactions--review and recommendations.
Explore the source record for details and available documents.
Blood Glucose↗
Enteroclysis--a technique for examining the small bowel.
Small bowel follow-through is the most commonly performed radiographic procedure for evaluation of the small bowel. However, recent advances in intubation and infusion techniques and the availability of improved barium suspensions have renewed interest in small bowel enteroclysis. Enteroclysis represents a significant improvement in the method of small bowel examination, yielding accurate diagnosis of a wide variety of lesions as well as confident demonstration of small bowel normality. Successful enteroclysis requires meticulous attention to technical and procedural details. The techniques of enteroclysis examination, diagnostic advantages, and clinical indications are elucidated in this review.
Barium Sulfate↗
Small-bowel imaging.
Explore the source record for details and available documents.
Diagnostic Imaging↗