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Biomedical subjects

D W Gelfand

Publications and source records attributed to D W Gelfand.

At least 127 records · Page 7Linked to original sources
PubMed1985

Endoscopic sensitivity in the detection of esophageal strictures.

Endoscopy was compared in 90 patients with a radiographic diagnosis of peptic esophageal stricture. Retrospectively, 78 strictures were classified as valid diagnoses giving a positive radiographic predictive value of 87%. Endoscopy diagnosed 74 (95%) of the 78 peptic strictures, detecting all 45 strictures under 10 mm in caliber, but failing to detect four (12%) of 33 broader strictures. Nine (75%) of the 12 radiographic false-positive errors involved misinterpretation of muscular or mucosal rings of the lower esophagus. We conclude that endoscopy and radiology are equally effective and complementary methods for evaluating patients with suspected peptic stricture.

Esophageal Stenosis↗
PubMed1985

Colonoscopy and the barium enema: a radiologic viewpoint.

Adherents of colonoscopy are recommending that it replace the radiologic examination as the initial diagnostic study of the colon. We present the radiologic view, supporting the barium enema as a more practical approach to initial diagnostic evaluation. The radiologic examination is an equally reliable, less costly, and much safer method for detecting colonic disease.

Barium Sulfate↗
PubMed1985

Detailed per-oral small bowel examination vs. enteroclysis. Part I: Expenditures and radiation exposure.

Time involved, patient reaction, and radiation exposure were compared for 25 patients undergoing a per-oral small bowel series and 18 having enteroclysis. For the per-oral study, mean room time was 17 minutes and fluoroscopy time was 4 minutes; for enteroclysis, mean room time was 44 minutes and fluoroscopy time was 22 minutes. Side effects were categorized as mild to moderate in two thirds of patients having enteroclysis, whereas they were minimal in 20% of those having the per-oral examination. Radiation exposure was five times greater for enteroclysis. These factors should be considered along with the age of the patient, indications for the examination, and the accuracy of the technique when planning a study of the small bowel.

Barium Sulfate↗
PubMed1985

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy.

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.

Crohn Disease↗
PubMed1985

Duodenitis: endoscopic-radiologic correlation in 272 patients.

Potential radiologic findings of duodenitis were investigated in 272 patients, 157 with endoscopically diagnosed duodenitis and 115 endoscopically normal controls. The study assessed the value of four signs: folds more than 4 mm thick, mucosal nodules, bulbar deformity, and erosions. The most sensitive signs were thickened folds (72.0%) and nodularity (48.4%), while demonstration of erosions was the least sensitive (10.8%). Overall sensitivity (77.7%) approximated that for the radiologic diagnosis of peptic ulcer or esophagitis. Radiologic specificity (76.5%) was in the same range.

Adolescent↗
PubMed1985

Anaphylactic and allergic reactions during double-contrast studies: is glucagon or barium suspension the allergen?

The authors report three anaphylactic reactions and one allergic reaction during double-contrast studies using glucagon. Symptoms included hives, periorbital edema, and breathing difficulties. Studies performed were three double-contrast barium enemas and one double-contrast upper gastrointestinal series. Glucagon injection and/or an additive in barium suspension are suspected as the likely causes. The allergic potential of glucagon injection, which is not generally appreciated, is reviewed.

Adolescent↗
PubMed1985

Methodologic considerations in comparing imaging methods.

Current methods for evaluating and comparing imaging methods may be inadequate in several important aspects. Prospective investigations often fail to provide uniform conditions for data collection due to variable physician skills in performing the studies being evaluated. The double-blind format, although seemingly objective, is inherently unable to prevent the effects of examiner or observer prejudice when imaging methods are being compared. Commonly used statistical terms are limited in their ability to characterize the clinical efficacy of imaging methods, and are easily misused. Reference examinations, or "gold standards," may be used in a manner preordaining an inferior result for the diagnostic method under evaluation. These problems are discussed and examples of their effects are presented. Suggestions are presented for minimizing existing methodologic limitations.

Diagnostic Errors↗
PubMed1985

Barrett esophagus as an extension of severe esophagitis: analysis of radiologic signs in 29 cases.

Twenty-nine cases of Barrett esophagus verified by endoscopy and 16 cases confirmed by histology were reviewed for pertinent radiologic signs. All patients had barium-filled and mucosal relief films, and all but five cases had double-contrast films. Common radiologic signs in descending order were thickened and irregular mucosal folds (28/29), hiatal hernia (26/29), esophageal stricture (25/29), esophageal ulcer (20/29), distal esophageal widening (19/29), granular mucosal pattern (16/24), reticular mucosal pattern (9/24), and intramural pseudodiverticula (6/29), all of which are also recognized signs of reflux esophagitis. Midesophageal stricture, esophageal ulcer, and distal esophageal widening were particularly indicative of Barrett esophagus. Since there appears to be no specific sign of Barrett esophagus, a multifaceted approach is suggested concentrating on the association of Barrett esophagus with the radiographic signs of severe reflux esophagitis.

Adolescent↗
PubMed1985

The radiologic detection of duodenal ulcers: effects of examiner variability, ulcer size and location, and technique.

Study of 91 endoscopically verified duodenal ulcers compared the effects of examiner variability, ulcer size and location, and radiographic technique on ulcer detection. Radiologic sensitivity of 61.5% was found for the entire group of 91 ulcers. Examiner variability was the strongest determinant of success; sensitivities for individual examiners ranged from 44.4% to 80%. Ulcer size was a second factor in radiologic detectability; ulcers 5 mm or larger were detected at a higher rate (80.0%) than those less than 5 mm (64.5%). Sensitivities of 65.9% and 57.4% were recorded for single- and double-contrast examinations, respectively, a statistically insignificant difference.

Adult↗
PubMed1985

Positive predictive value and examiner variability in diagnosing duodenal ulcer.

The positive predictive value of a diagnosis of duodenal ulcer was studied in 255 patients with 274 ulcers diagnosed radiographically. Retrospective analysis of the radiographic examinations and correlation with endoscopy assessed examiner variability, ulcer size, duodenal bulb deformity, and the confidence level of the ulcer diagnoses. For all diagnoses, the overall positive predictive value was 57% with individual predictive values of 47%, 54%, and 70% among three examiners. The individual predictive values correlated directly with the average level of confidence of the diagnoses for each examiner. The sensitivity of the individual examiner for ulcer detection had an inverse relation to the examiner's positive predictive value, confirming that higher sensitivities are achieved at the expense of an increased false-positive rate.

Duodenal Ulcer↗
PubMed1984

The extent of successful colonoscopy: a second assessment using modern equipment.

Records of 200 consecutive and unselected colonoscopies were reviewed to determine both the success in viewing the entire colon and the average extent of colon visualized, using the most modern equipment. Colonoscopy was completed to the cecum or ileum in 82.5% of studies, and an average of 93.8% of the colon was viewed. These data show considerable improvement compared to those previously reported by us. However, the significant number of incomplete colonoscopies still suggests that colonoscopy and barium enema examination must remain complementary for maximum detection of colonic lesions.

Barium Sulfate↗
PubMed1984

Radiographic evaluation of the achalasic esophagus immediately following pneumatic dilatation.

Sixteen patients with achalasia of the esophagus were treated by fluoroscopically guided pneumatic dilatation. All patients were examined radiographically immediately following dilatation. The caliber of the esophagogastric region increased from a pretreatment mean of 5.3 mm to 9.6 mm following dilatation. The margins of the dilated area remained smooth in 6 patients (38%) and became irregular in 10 (62%). Initial symptomatic improvement was found in 14 patients (88%) with a mean follow-up of 1.7 months. One (6%) perforation occurred, necessitating surgery. The radiographic appearance of the esophagogastric region following pneumatic dilatation, however, poorly predicted patient response.

Adult↗
PubMed1984

Cold barium suspensions in the clinical evaluation of the esophagus.

Cold barium suspensions have been shown to reduce primary esophageal peristalsis and improve distention of the lower esophagus and esophagogastric region. Cold barium is a useful adjunct to the standard radiographic examination when adequate distention of the esophagus has not initially been achieved. It is particularly applicable to evaluation of reflux esophagitis and esophageal strictures and rings.

Barium↗
PubMed1984

A computer-assisted radiologic reporting system.

The patient registration and interpretation/reporting modules of a computer-assisted radiologic reporting system are described. Entries may be made at several levels of complexity, using bar codes or keyboard input. Several functions allow convenient access to the database. Output may be reformatted without programmer intervention via a maintenance file. The system allowed improved turnaround time, reduced costs, and better understanding of work patterns.

Computers↗
PubMed1984

The location and size of gastric ulcers: radiologic and endoscopic evaluation.

The location and size of 132 gastric ulcers were evaluated radiologically and endoscopically. Results suggest that the classically noted concentration of ulcers along the lesser curvature and in the distal stomach remains valid despite changes in diagnostic methods. It was also found that proximally located ulcers tend to be larger than those elsewhere, whereas those in the distal stomach are smaller. Concentration of ulcers in the proximal stomach in elderly patients, as suggested by previous authors, could not be confirmed.

Adult↗