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Biomedical subjects

D W Gelfand

Publications and source records attributed to D W Gelfand.

At least 109 records · Page 6Linked to original sources
PubMed1987

Optimizing single- and double-contrast colon examinations.

Recent technical advances have greatly increased the effectiveness of barium enema examinations for detection of common diseases of the colon. As documented in the literature, the double-contrast enema may equal or exceed colonoscopy in detection of colonic neoplasms and, with proper technique, the single-contrast enema may also closely approach these results. This presentation reviews recent technical improvements in the areas of radiographic-fluoroscopic equipment, fluoroscopic images, film-screen combinations, barium suspensions, examination techniques, filming sequences, and quality controls. These are employed to optimize both the double- and single-contrast barium enemas to where their sensitivities are competitive with endoscopy.

Air↗
PubMed1986

Radiological evaluation of dysphagia.

Radiological examination evaluates both structural and functional abnormalities of the esophagus in patients with dysphagia. Combined with the clinical history, the radiological results can guide the clinician to a specific diagnosis, such as carcinoma or stricture, or to additional studies, such as endoscopy or esophageal manometry. Based on cost and diagnostic efficacy, the radiological method, compared with endoscopy, is most useful as the initial screening examination in patients with dysphagia (Table 2). Its major limitations are poor detection of mild cases of esophagitis and occasional lack of specificity in diagnosing esophageal motor dysfunction. To achieve these results, however, effective radiological evaluation of the esophagus requires the meticulous use of a combination of examining techniques.

Contrast Media↗
PubMed1986

Analysis of a multiphasic radiographic examination for detecting reflux esophagitis.

Radiographic and endoscopic findings were correlated in 46 normal patients and in 49 with reflux esophagitis to assess the efficacy of a multiphasic examination employing mucosal relief full-column, and double-contrast techniques. Esophagitis was graded endoscopically as mild, moderate, or severe, and the quality and sensitivity of each technique and of the examination as a whole were determined. The radiographic specificity in the normal patients was 98%. The overall sensitivity was 65% for all grades of esophagitis, and 90% for the moderate and severe grades. Sensitivities of the individual techniques were: mucosal relief: 43%; full-column: 53%; double-contrast: 45%. These differences were not statistically significant. We conclude that a combination of radiographic techniques is needed to detect reflux esophagitis optimally.

Esophageal Stenosis↗
PubMed1986

Retrograde examination of the small bowel in patients with an ileostomy.

The retrograde small-bowel examination is a convenient method for studying the small bowel in patients with an ileostomy. Adhesions, recurrent Crohn's disease, ileostomy dysfunction due to prestomal narrowing, and obstruction due to neoplasm are demonstrable. The technique described is faster than the peroral examination or enteroclysis, does not cause patient discomfort, and produces a rapid examination of the entire small bowel in any patient with an ileostomy.

Adolescent↗
PubMed1986

Radiographic magnification of colon polyps.

Radiographic magnification was evaluated on conventional and remote control machinery using a phantom with steel rods positioned at different levels. Depending on the rod-film distance, the range of magnification was 8-47% on remote control and conventional overhead films and 11-82% on conventional fluoroscopic spot-films. Extrapolation to the colon based on cross-sectional anatomic correlation showed a 14-27% variation in the radiographic magnification depending on the machinery used, the segment of the colon considered, and the position of the patient. This implies that substantial inaccuracy in the measurement of colonic polyps is common by barium enema examination, particularly when a conventional fluoroscope is used.

Colonic Polyps↗
PubMed1986

Single-contrast vs double-contrast barium enema in the detection of colonic polyps.

Radiographic and colonoscopic correlation in 139 patients with 234 colonic polyps compared the sensitivity of single- and double-contrast barium enema. Single-contrast barium enema detected 68 (80%) of polyps, with 72% of polyps under 1 cm and 94% of those 1 cm or over detected. Double-contrast barium enema detected 135 (91%) of 149 polyps, with 88% of polyps under 1 cm and 96% of larger polyps detected. Thus, the double-contrast barium enema was more effective than the single-contrast examination only for detection of polyps under 1 cm. The single-contrast barium enema was more likely performed on patients in poor physical condition and in those over 70 years old. The results suggest that for elderly patients, who may have difficulty in cooperating for a double-contrast enema, a properly performed single-contrast examination is an acceptable option.

Adenoma↗
PubMed1986

Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring.

Radiographic and endoscopic sensitivities were compared in 60 patients with lower esophageal mucosal ring. Barium esophagram detected 57 (95%) rings, all shown by the prone full-column technique. Double-contrast technique in 39 patients demonstrated only 18 (46%) rings. Endoscopy detected 35 (58%) of 60 rings. Endoscopic sensitivity depended on ring caliber with detection of 18 (82%) of 22 rings 13 mm or less in caliber, 14 (54%) of 26 14-19 mm rings, and three (25%) of 12 rings 20 mm or wider. Dysphagia was present in 13 of 25 patients with rings undetected by endoscopy. The caliber of the fiberoptic instruments used also affected endoscopic detection, with 47% of the rings being diagnosed with narrower endoscopes and 76% being diagnosed with larger instruments. Thus, the radiographic examination was more accurate in detecting lower esophageal mucosal ring and should be used initially in patients with dysphagia and suspected lower esophageal narrowing.

Adult↗
PubMed1986

Radiologic and manometric correlation in "nutcracker esophagus".

"Nutcracker esophagus" is a newly described esophageal motor disorder seen in some patients with chest pain and/or dysphagia and characterized manometrically by normal primary peristalsis with distal contractions of high amplitude. The radiographic and manometric examinations in 20 patients with nutcracker esophagus were correlated. Normal primary peristalsis was observed radiographically in 16 patients, and a nonspecific motor disorder was diagnosed in the remaining four patients. Mild-to-severe nonspecific tertiary activity was seen in about half of the patients, esophageal wall thickness was normal. It is concluded that nutcracker esophagus is primarily a manometric diagnosis made in the appropriate clinical setting, and that the radiographic findings are normal or nonspecific.

Adult↗
PubMed1986

Radiographic efficacy in gastric ulcer: comparison of single-contrast and multiphasic examinations.

The efficacies of single-contrast and multiphasic examinations of the stomach for gastric ulcer detection were compared in 90 patients with 102 gastric ulcers, and in a control group of 382 patients without gastric ulcer. Single-contrast and multiphasic sensitivities were 62% and 64%, respectively. Radiographic detection depended significantly on ulcer size: Only 24% of ulcers under 5 mm were detected, compared with 89% of ulcers 5 mm or larger. Radiographic specificities and positive predictive values were similar for both types of examination. Moderate variation of the sensitivities and specificities of the three radiologists was observed, with ranges of 53-69% and 90-98%, respectively. Results indicated that gastric ulcer detection is more related to ulcer size and to individual interpretive variations than to the type of examination.

Adolescent↗
PubMed1985

Upper gastrointestinal series: patient management and a study of 199 cases.

Records of 199 patients were analyzed retrospectively after upper gastrointestinal (UGI) series to assess its impact on patient management. Symptoms most predictive of an abnormal UGI series were dysphagia, UGI hemorrhage, abdominal pain, and chest pain. However, 23% of inpatients with seemingly trivial symptoms had shown abnormal results of the study. Overall sensitivity of the UGI series was 65%, which rose to 82% if esophagitis, gastritis, and abnormalities of the postoperative stomach were excluded. Effects on patient management included: serious pathologic change ruled out (53%), further studies ordered (21%), change of therapy (17%), existing therapy continued (16%), surgery performed (7%), and radiologic abnormality ignored (5%). In no case did the combination of initial screening by UGI series followed by endoscopy as indicated lead to subsequently reported morbidity or mortality due to a failure of diagnosis.

Digestive System↗
PubMed1985

Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques.

Three hundred multiphasic examinations of the lower esophagus and esophagogastric region were assessed to determine the individual sensitivities of the full-column, mucosal relief, and double-contrast techniques in the detection of common structural abnormalities, such as hiatal hernia, lower esophageal rings, and peptic strictures. In 159 patients, there were 211 structural abnormalities including 153 hiatal hernias, 35 mucosal rings, 20 peptic strictures, and 3 esophageal diverticula. The overall sensitivity of the full-column technique in detecting these abnormalities was 100% compared to 52% and 34% for the mucosal relief and double-contrast techniques, respectively. We conclude that the prone full-column technique must be incorporated into any examination of the esophagogastric region if these common abnormalities are to be demonstrated reliably.

Adolescent↗
PubMed1985

Predictive relationship of hiatal hernia to reflux esophagitis.

The relationship between hiatal hernia and reflux esophagitis was compared in 93 patients who underwent both radiographic and endoscopic examination of the esophagus. In 46 patients with a normal esophagus shown endoscopically, hiatal hernia was present in 59%, while 94% of 47 patients with reflux esophagitis had hiatal hernia. The positive and negative predictive values for hiatal hernia in diagnosing or excluding esophagitis were 62% and 86%, respectively. Extrapolation of these data and review of the literature suggest that much of the confusion concerning the relationship between hiatal hernia and reflux esophagitis is based on reports of populations with considerable variation in the prevalence of esophagitis and in which the radiographic criteria for diagnosing hiatal hernia have not been uniformly applied.

Esophagitis, Peptic↗