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Biomedical subjects

F M Kelvin

Publications and source records attributed to F M Kelvin.

At least 73 records · Page 4Linked to original sources
PubMed1982

The peroral pneumocolon: its role in evaluating the terminal ileum.

Peroral pneumocolon examination was performed on 40 patients for further radiographic evaluation of the terminal ileum after antegrade small bowel study. Patients were selected because of poor visualization of the terminal ileum on routine study (17 patients), clinically suspected Crohn disease but normal terminal ileum on routine study (ten), abnormal terminal ileum on routine study (seven), and previous ileocolic anastomosis (six). Use of the technique resulted in additional diagnostic information in 20 (50%) of the 40 patients. Its main value was in showing a previously poorly visualized terminal ileum to be normal (eight patients) and in confirming a normal terminal ileum in clinically suspected Crohn disease (six). In addition, it more precisely defined the proximal extent of recurrent ileal Crohn disease in two patients and detected otherwise unrecognized early ileal Crohn disease in one patient. The technique can be carried out immediately after any antegrade small bowel examination, and if reserved for the above indications, is a valuable adjunct to routine compression spot films of the terminal ileum or reflux study of the terminal ileum at barium enema.

Air↗
PubMed1982

Radiologic investigation of peptic ulcer disease.

Fiberoptic endoscopy has uncovered some of the weaknesses with the traditional upper gastrointestinal series and has prompted more critical evaluation of the radiographic examination of the stomach. The biphasic examination using gas distention as well as thick and thin barium suspensions incorporates the best features of both single- and double-contrast examinations. The radiologist needs to be aware of the different signs of ulcer disease as demonstrated by the two different types of examinations, and attention to technical details is critical if thick barium coating is really going to produce striking anatomic detail. Knowing the radiographic features of the common and uncommon manifestations of peptic ulcer disease is important for the radiologist performing gastrointestinal studies. By performing technically excellent studies and by recognizing the various manifestations of peptic ulcer disease, the radiologist will continue to play an important role in diagnosing suspected or known peptic ulcer disease.

Duodenal Ulcer↗
PubMed1982

Radiologic approach to the detection of colorectal neoplasia.

Patients with early colorectal carcinoma detected by screening have a high survival rate. Most colorectal carcinomas evolve in preexisting adenomatous polyps, and the incidence of this malignant disease can be reduced by endoscopic polypectomy. Radiologic examination usually cannot differentiate between a benign polyp and a small carcinoma, which heightens the importance of their colonoscopic removal and subsequent histologic examination. The double-contrast enema has a higher degree of sensitivity for the detection of polyps, and probably also for early carcinoma, than the single-contrast enema. Because many of these lesions are asymptomatic, the double-contrast enema should be the standard radiologic examination of the colon in adults. This view has been championed by others and the technique has become more widely adopted. Its use contributes to the effort to reduce mortality from colorectal carcinoma.

Adenocarcinoma↗
PubMed1981

Radiologic spectrum of polypoid lesions in ulcerative colitis and Crohn's disease.

Various types of polypoid lesions are found in patients with ulcerative colitis and Crohn's disease. True adenomatous polyps are rare. In addition to the sessile or pedunculated "pseudopolyps" of inflammatory bowel disease, the lesions may also assume a filiform shape or reach a giant size. These polypoid lesions are inflammatory in nature and therefore have no malignant potential. Awareness of the benign nature of these lesions is important in the management of patients with inflammatory bowel disease. Unnecessary surgery may be prevented by endoscopic biopsy for confirmation of their inflammatory nature. Representative cases illustrate the ability of the double contrast technic to clearly depict these polypoid lesions.

Adult↗
PubMed1981

Pancreatic abscess: importance of conventional radiology.

To determine the clinical usefulness of conventional radiographic methods in pancreatic abscess, studies from 35 patients were retrospectively evaluated. Plain films of the abdomen were obtained in 31 and showed the diagnostic finding of extraluminal gas in the pancreatic area in 18 (58%). Gastrointestinal contrast studies were done in 28 patients and confirmed the extraluminal location of abscess gas in 17 (61%). These contrast studies provided important preoperative evidence of perforation or fistula in six (21%) patients. Because of the risk of extravasation in complicated pancreatic abscesses, water soluble contrast media are recommended instead of barium. Abscess gas was shown by computed tomography (CT) in four (50%) of eight patients and sonography suggested a diagnosis in five (31%) of 16. In aggregate all radiographic methods demonstrated evidence of a pancreatic abscess in 69%. While sonography and CT are being used with increasing frequency, this experience reaffirms the value of plain film and gastrointestinal contrast studies in patients with suspected pancreatic abscess.

Abscess↗
PubMed1981

Colorectal carcinoma missed on double contrast barium enema study: a problem in perception.

A total of 31 cases of primary colorectal carcinoma missed on double contrast barium enema studies over a 5 year period (1976-1980) were collected from six institutions, and the causes of error reviewed. The errors were purely perceptive in 52%, due to a combination of perceptive and technical factors in 32%, and interpretative in 6%. The most common perceptive mistakes were failure to recognize a filling defect in the barium pool and failure to detect the tumor en face in double contrast study. Five cases were only detected at the time of the study as a result of double reading. Ten percent of the lesions could not be seen in retrospect, and therefore can be attributed to failure of the technique itself. At four of the institutions, the double contrast barium enema study missed 11 (6%) of 197 primary colorectal carcinomas. The lesion was invisible in retrospect in only two (1%) of these 197 studies, indicating that the double contrast examination is potentially highly sensitive for detecting colorectal carcinoma. The mainly perceptive nature of the errors indicates the need for more careful viewing of double contrast barium enemas. Familiarity with the different appearances of colorectal carcinoma on double contrast study, together with double-reading by the same or different observers, should reduce the incidence of missed lesions.

Barium Sulfate↗
PubMed1981

Radiologic diagnosis of Crohn disease (with emphasis on its early manifestations).

Crohn disease can affect any part of the gastrointestinal tract. The early manifestations of the disease are readily recognizable in the colon if double-contrast technique is employed. Small bowel and gastroduodenal involvement in the early stages have been less frequently identified, but enteroclysis and double-contrast UGI examination have yielded encouraging results. There is some evidence that failure to utilize the double-contrast barium enema and enteroclysis contributes to delay in diagnosis of Crohn disease. Use of these more sophisticated techniques is encouraged. As follow-up radiography in Crohn disease appears less indicated than previously considered, it is particularly important that initial assessment employs the most sensitive and accurate radiographic techniques available.

Adult↗
PubMed1980

Clostridium septicum infection associated with colonic carcinoma and hematologic abnormality.

Six patients with Clostridium septicum sepsis seen at Duke University Medical Center over a two-year period also had other abnormalities, consisting of hematologic disorders in 3 and colon tumors in 3. Three patients died of sepsis; 2 survived following disarticulation of the arm to control gas gangrene, while the sixth patient survived the sepsis but died of metastatic disease. When anaerobic cultures are positive for C. septicum, antibiotics should be given immediately. The high incidence of underlying colon tumor, especially in the cecum, should prompt consideration of a barium-enema examination.

Adenocarcinoma↗
PubMed1980

Double contrast technique in the proximal stomach.

The double contrast technique is of particular value in the proximal stomach, where one is able to detect ulcers and masses not recognized on a conventional upper gastrointestinal series. Pseudotumors which may occur in the fundus with the conventional barium technique are readily resolved. When a lesion in the proximal stomach is suspected by conventional radiography, immediate use of double contrast radiography may confirm or better delineate the lesion. Double contrast examination of the proximal stomach may thus be used as a primary or immediate secondary procedure to increase radiologic accuracy.

Adenocarcinoma↗
PubMed1979

Diagnosis and surgical treatment of colonic endometriosis.

Endometriosis is sufficiently common that it should always be considered in the differential diagnosis of colon lesions of women of childbearing age. Seven selected cases illustrate problems in diagnosis and management of endometriosis of the colon. Characteristic of colon endometriosis are large bowel symptoms frequently associated with gynecologic complaints, usual sigmoid and rectosigmoid location, extramucosal radiologic appearance, and difficult diagnosis by endoscopic biopsy. Suspicion of malignancy and presence of a symptomatic colon lesion are indications for bowel resection, which is an effective form of therapy.

Adult↗
PubMed1979

Double contrast examination of the upper gastrointestinal tract.

The principles and technic of the double contrast examination of the esophagus, stomach, and duodenum are outlined. Use of the hypotonic agent glucagon improves evaluation of the stomach, but optimal visualization of the duodenum may require reexamination after its effect has worn off. The technic is able to show gastric erosions and linear ulcers, both of which are rarely recognizable with conventional examination. The characteristics of malignant gastric ulcers and the presence of fundal lesions are also better demonstrated on double contrast evaluation. Small esophageal carcinomas may be recognized on a double contrast barium swallow. Examples of each of these lesions are illustrated. Many ulcerating lesions are seen "en face" on double contrast, and not in profile, which may require relearning the interpretation of their appearances. For greatest accuracy the double contrast technic should be combined with the conventional examination. As this therefore becomes a more time-consuming examination, we advocate its use only in selected clinical situations rather than on a routine basis.

Adenocarcinoma↗
PubMed1979

Lymphoid follicular pattern of the colon in adults.

The clinical and radiographic findings of the colonic lymphoid follicular pattern in 37 adults aged 20-79 years were evaluated. An incidence of 13% was found on review of 100 consecutive double-contrast barium enemas. Usually, the presence of multiple 1-3 mm diam, uniform-size nodules is sufficiently characteristic to make a presumptive diagnosis on these radiographic criteria. The nodules are often not visible endoscopically. The clinical data suggest that that the lymphoid follicular pattern is usually of no clinical significance in adults. In most patients, its radiologic pattern can be distinguished from entities such as familial polyposis and early Crohn's disease, thus sparing the patient unnecessary further diagnostic evaluation.

Adult↗
PubMed1978

The spectrum of small bowel melanoma.

Twenty-one patients with documented secondary small bowel involvement by malignant melanoma are reviewed. Roentgen mainfestations are discussed and illustrated. A vigorous diagnostic approach emphasizing enteroclysis is described. Clinical awareness and aggressive radiologic investigation are providing these patients with earlier surgical and adjuvant therapy, which appears to be leading to increased length of survival.

Adolescent↗
PubMed1978

Extraperitoneal gas following nephrectomy: patterns and duration.

The amount and duration of extraperitoneal gas in normal patients after major renal operations have not been documented. This air may be difficult to separate from that owing to abdominal abscess and, therefore, can be a potential source of diagnostic error in the febrile postoperative patient. A prospective study was performed on 41 postoperative patients to determine the incidence, duration and pattern of extraperitoneal gas in patients undergoing renal operations. No patient had an abscess. Of the abdominal films obtained between 1 and 4 days postoperatively 92 per cent demonstrated gas, 71 per cent were positive between 5 and 8 days and 61 per cent were positive between 9 and 12 days postoperatively. Over-all, 34 of 41 patients had extraperitoneal gas demonstrated on the postoperative abdominal radiographs. Linear and bubbly patterns were demonstrated and, in many cases, the appearance was indistinguishable from that of an abscess. It is important that the benign nature of this postoperative gas be appreciated and not mistaken for an abdominal abscess.

Abdomen↗
PubMed1978

Chronic oesophageal stricture due to moniliasis.

A case of persistent oesophageal stricture due to moniliasis, which developed while the patient was symptomatic, is reported. The value and therapeutic implications of performing a repeat barium swallow even if the disease appears to be quiescent are discussed.

Adolescent↗
PubMed1978

Double contrast barium enema in Crohn's disease and ulcerative colitis.

Double contrast barium enema examinations in 24 patients with Crohn's disease of the colon and 29 patients with ulcerative colitis were reviewed without knowledge of the clinical diagnosis. The radiologic diagnosis of Crohn's disease agreed with the clinical diagnosis in 98% of patients. In this condition the most common radiologic findings were discontinuous or asymmetric disease (88%) and discrete ulcers (67%) often on a normal mucosa. The latter are characteristic of early Crohn's disease and may enable the radiologist to be the first to suggest the diagnosis, particularly when both sigmoidoscopy and small bowel examination are normal. Of the patients with ulcerative colitis, a positive radiologic diagnosis was made in 83% on the basis of a granular mucosal pattern (79%) and continuous distal involvement (86%). The high accuracy of the double contrast technique, especially in Crohn's disease, and the relative specificity of the signs that it can demonstrate suggest that this is the preferred examination in the radiologic evaluation of inflammatory bowel disease.

Adolescent↗
PubMed1978

Radiologic evaluation of acute abdominal pain arising from the alimentary tract.

A review of the pertinent radiologic findings of common alimentary tract disorders presenting with acute abdominal pain is presented. When the conventional plain abdominal films are not diagnostic, the use of special views and appropriate contract and ultrasound examinations on a urgent basis is encouraged. A more expenditious and accurate diagnosis of the cause of abdominal pain will inevitably reduce the morbidity and mortality of such entities as bowel perforation, infarction, and pancreatitis.

Abdomen, Acute↗