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Biomedical subjects

D W Gelfand

Publications and source records attributed to D W Gelfand.

At least 19 recordsLinked to original sources
PubMed2001

Gastritis: classification, pathology, and radiology.

Gastritis has a broad pathologic spectrum and anatomic distribution, as well as an evolving etiology. The Sydney pathologic classification of gastritis, which appeared in 1990 and was revised in 1994, emphasized the importance of combining etiologic, topographic, and morphologic criteria for establishing clinically useful diagnoses. Using this revised Sydney pathologic classification as a guide, we report a simpler and more practical radiologic approach to gastritis. We emphasize those types of gastritis that may be detected on radiologic examination and illustrate typical findings.

Gastritis↗
PubMed2000

Is it necessary to biopsy the obvious?

OBJECTIVE: The radiologist and oncologist are often confident that biopsy will confirm their suspicion of recurrent disease, but a biopsy is performed to confirm the histologic diagnosis before beginning or altering therapy. We have examined data to determine how often the biopsied lesion represents recurrent disease from the primary tumor or is an instance of new cancer, and whether recurrent disease can be predicted. MATERIALS AND METHODS: We reviewed the medical and imaging records of 253 patients who underwent CT-guided biopsy of an abdominal or pelvic lesion between 1993 and 1996. Sixty-nine of the 253 patients had a previously diagnosed primary tumor and were being examined for possible tumor recurrence or metastasis. The images of these 69 patients were analyzed to determine if the pattern of disease was typical of recurrence or metastasis. RESULTS: In 55 of the 69 patients, the pattern was judged to be typical of metastatic or recurrent disease. Biopsy confirmed this suspicion in all 55 patients. In 14 of the 69 patients, the pattern of spread was judged not to be typical of recurrence or metastasis. These 14 patients were found to have a new primary tumor (n = 4), benign processes (n = 2), and recurrences (n = 8). CONCLUSION: Of the patients for whom radiographic findings suggested recurrence, we found no patients in whom a new primary tumor would have been missed if biopsy had been avoided. Data should now be acquired prospectively to determine whether it may be prudent to make treatment decisions on the basis of imaging findings alone, without histologic confirmation.

Abdominal Neoplasms↗
PubMed1999

Free jejunal grafts of the pharynx: surgical methods, complications, and radiographic evaluation.

Free jejunal grafts have been used in the surgical treatment of patients with carcinoma of the pharynx and upper esophagus. Post-operative complications, including swallowing difficulty, are frequent and radiographic assessment may be required. In this pictorial paper, we describe the surgical technique of free jejunal grafting of the pharyngoesophagus, and the radiographic appearances and clinical importance of early and delayed complications following the procedure. Dysphagia after placement of a jejunal graft is a common occurrence which is often multifactorial, and may be related to functional, anatomic, or a combination of factors.

Carcinoma, Squamous Cell↗
PubMed1999

Reflux evaluation: correlation between pH results, esophagitis, esophageal dysmotility, patient age, and esophageal caliber.

The purpose of this study was to correlate gastroesophageal reflux evaluated by 24-h pH study to esophageal motility, diameter of the esophagus and diaphragmatic hiatus, and patient age. We recorded radiographic findings from barium esophagrams in 91 patients (47 women, 44 men) with a mean age of 52 years (range 17-18 years), who had 24-h pH monitoring of the esophagus. All patients had one or more symptoms related to the upper aerodigestive system, and both studies were performed within 2 days of each other. The average diameters of the esophagus and hiatus were 24 mm and 19 mm respectively. The correlation coefficient (r) between patient age and diameter of the esophagus was -0.22. No correlation was found between the diameter of the hiatus and the size of the esophagus or patient age. Esophageal diameter is significantly wider in patients with esophagitis than in patients who have no esophagitis. Thirteen of 27 patients with absent primary peristalsis had abnormal pH results. The diameter of the esophagus may be affected by aging, but was not affected by the presence of dysmotility. The caliber of the hiatus was stable and was narrower than the diameter of the esophagus. The hiatus tended to be wider when esophagitis existed.

Adolescent↗
PubMed1998

Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.

OBJECTIVE: The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus. SUBJECTS AND METHODS: Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded. RESULTS: Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms. CONCLUSION: Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.

Adolescent↗
PubMed1997

The future of barium radiology.

Barium radiology of the gastrointestinal tract has had a long history but its survival into the next century will be a challenge. The numbers of barium studies performed has declined in recent decades due to several factors; also, health care reforms in the United States will further impact on the use of barium examinations. The future status of these radiological procedures will change depending on these factors and the organ system being examined; an increased emphasis on functional evaluation of the gastrointestinal tract will also have an effect on the evolving role of barium radiology. We provide a brief historical review of the evolution of barium radiology in the twentieth century, discuss the present and changing status of the various gastrointestinal examinations, and offer our thoughts concerning the potential future of this specialty.

Barium Sulfate↗
PubMed1997

Cost-effective poster and print production with digital camera and computer technology.

OBJECTIVE: The purpose of this report is to describe a cost-effective method for producing black-and-white prints and color posters within a radiology department. CONCLUSION: Using a high-resolution digital camera, personal computer, and color printer, the average cost of a 5 x 7 inch (12.5 x 17.5 cm) black-and-white print may be reduced from $8.50 to $1 each in our institution. The average cost for a color print (8.5 x 14 inch [21.3 x 35 cm]) varies from $2 to $3 per sheet depending on the selection of ribbons for a color-capable laser printer and the paper used. For a 30-panel, 4 x 8 foot (1.2 x 2.4 m) standard-sized poster, the cost for materials and construction is approximately $100.

Copying Processes↗
PubMed1997

Decreased risk of subsequent colonic cancer in patients undergoing polypectomy after barium enema: analysis based on data from the preendoscopic era.

OBJECTIVE: Published data from the Mayo Clinic gathered during the preendoscopic era were analyzed to show that the risk of subsequent colonic carcinoma is reduced in patients with benign-appearing polyps that are revealed by radiology who then undergo polypectomy. MATERIALS AND METHODS: Data from the Mayo Clinic gathered during a 6-year period before the availability of endoscopy were used to determine the effect on the subsequent risk of colonic carcinoma if the benign-appearing polyps initially revealed by radiology had been removed rather than left in place and followed up by serial barium enemas. Data were from 226 patients with benign-appearing polypoid lesions of the colon that were 1 cm in diameter or larger and had been followed up by periodic barium enemas. The period of radiologic surveillance was 12-229 months (mean, 68 months). Between two and 17 barium enemas (mean, 5.2) were performed on each patient. The clinical follow-up period was 12-242 months (mean, 140 months). RESULTS: Twenty-one adenocarcinomas developed at the site of the index polypoid lesion as found on follow-up barium enema examinations of these patients. Eleven additional adenocarcinomas of the colon were found at sites remote from that of the index lesion. If the index polyp had been removed when initially diagnosed radiologically, 66% fewer subsequent carcinomas would have occurred in these patients during the average of 11 years of clinical follow-up. CONCLUSION: Excision of benign-appearing polyps found on initial barium enema examinations would result in a significant decrease in the subsequent risk of colonic adenocarcinoma.

Adenocarcinoma↗
PubMed1997

Colorectal cancer. Screening strategies.

Colorectal cancer is both curable and preventable; however, systemic screening has not yet been instituted in the United States. There are a number of diagnostic tests, imaging procedures, and endoscopic examinations available to detect colorectal cancer and polyps in their early stages. This article reviews these various screening options and concludes that the barium enema is the most cost-effective method.

Colorectal Neoplasms↗
PubMed1997

Heartburn correlated to 24-hour pH monitoring and radiographic examination of the esophagus.

OBJECTIVES: Study relationship of gastroesophageal reflux disease to findings on radiographic examination of the esophagus. METHODS: We correlated heartburn (HB) in 360 patients (174 women; 186 men; mean age, 53 yr) to results of pH monitoring (pHM) and radiographic examination of the esophagus. Radiographic findings were categorized as normal (n = 129), hiatal hernia (HH) only (n = 173), reflux esophagitis (n = 50), or peptic stricture (n = 8) (ES; 58). Abnormal pHM was defined as total percentage of esophageal acid exposure time (pH < 4) of 6% or greater. RESULTS: pHM was abnormal in 41 (31%) of 132 patients with HB versus 54 (24%) of 228 without the symptom (p > 0.05). Radiographic correlation showed abnormal pHM in only 21 (16%) of 129 patients with a normal esophagus, 52 (30%) of 173 with HH, and 22 (38%) of 58 with ES, which was significantly lower for those with a normal esophagus. In 132 patients with HB, those with normal esophagus had lower abnormal pHM (2 of 38; 5%) compared with patients with HH (24 of 64; 38%) or with ES (15 of 30; 50%) (p < 0.05). In the 228 patients without HB, abnormal pHM was found in 19 (21%) of 91 with a normal esophagus, 28 (26%) of 109 with HH, and 7 (25%) of 28 with ES (p > 0.05). CONCLUSIONS: (1) pHM findings did not correlate with presence or absence of HB; (2) pHM is usually normal in patients with normal esophagus on RE; (3) pHM is also usually normal in patients with HB and normal esophagus on RE; and (4) pHM is often normal in patients with radiographic findings of reflux esophagitis or peptic stricture.

Esophageal Stenosis↗
PubMed1996

Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations.

Clinical and videofluoroscopic evaluation of swallowing were correlated to determine their agreement and relationship to feeding recommendations. We reviewed a total of 148 patients with swallowing difficulties, of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials were used for clinical bedside evaluation of oral and pharyngeal function. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the examinations were compared. The combined results of both evaluations generated an index of swallowing difficulty which was correlated to the type of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, clinical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not determined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its severity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had enteral feedings. In conclusion, combined clinical and radiographic examinations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing severity correlated well with final feeding recommendations.

Barium↗
PubMed1996

Functional abnormalities of the pharynx: a prospective analysis of radiographic abnormalities relative to age and symptoms.

PURPOSE: To determine the prevalence and severity of functional abnormalities of the pharynx relative to patient age and symptoms. MATERIALS AND METHODS: Radiographic evaluation of the pharynx was performed in 110 consecutive outpatients aged 19-84 years old who had no previous surgery of the larynx, pharynx, or esophagus. Each patient completed a symptom data sheet, and we reviewed medical records to determine the main indication for each examination. Videofluoroscopy and static filming in frontal and lateral positions were done with 20-ml barium boluses. We then evaluated functional abnormalities and classified abnormal findings by type and severity. RESULTS: We categorized patients by age into three groups: less than 40 years old (n=31), between 40 and 60 years old (n =42), and greater than 60 years old (n=37). We found a significant increase in the prevalence (23%, 36%, 57%, respectively) and severity of functional abnormalities of the pharynx in older patients (p < .05). Laryngeal penetration, aspiration, pharyngeal stasis, and cricopharyngeal bar were the main abnormalities found in the two older groups. However, we found no correlation between functional abnormalities of the pharynx and symptoms and indications (p > .05). CONCLUSION: Functional abnormalities of the pharynx increased in prevalence and severity with age. Often these findings were not related to specific pharyngeal symptoms and must be interpreted cautiously in older patients.

Adult↗