Biomedical subjects

Frederick M Kelvin

Publications and source records attributed to Frederick M Kelvin.

6 recordsLinked to original sources

PubMed2003

Current concepts in imaging of small bowel obstruction.

The diagnosis and treatment of small bowel obstruction continue to evolve. The imaging approach in the work-up of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this disease have undergone considerable changes over the past two decades. This article examines the current concepts related to the use of imaging technology in the diagnosis and management of patients with small bowel obstruction. The meaning of frequently used but poorly defined terms in describing intestinal obstruction is clarified and illustrated.

Barium Sulfate↗

PubMed2003

Multidetector-row helical CT enteroclysis.

Currently, CT-E is not recommended as the first-line examination in patients when mucosal detail is required. Double-contrast barium air enteroclysis has advantages in demonstrating small mucosal abnormalities. The authors find CT-E of value in the work-up of patients with symptoms of intermittent small bowel obstruction, particularly those with a history of prior abdominal surgery; in the further work-up of selected patients with high-grade obstruction in whom general surgeons prefer initial conservative management (immediate postoperative small bowel obstruction, patients with history of prior abdominal surgery for malignant tumor, history of radiation treatment, and possible internal extraintestinal fistulae); in looking for complications of small bowel Crohn's disease; and in the patient with unexplained anemia or gastrointestinal bleeding. In a series of patients who had both abdominal CT and barium enteroclysis done, each examination provided unique and complimentary diagnostic information. Because CT-E combines the advantages of both methods of examination, is it the optimum imaging work-up in the investigation of small bowel disease? Further research and clinical experience will define the precise role of CT-E in the investigation of small bowel disease. Experience with this method of examination is limited to a few institutions, performed by investigators with interest in small bowel diseases. The addition of cross-sectional display and multiplanar reformatting made possible by multidetector-row helical CT to enteral volume change and the use of multifunctional nasointestinal catheters make CT-E an important tool in the investigation of small bowel disease. Experience has shown the increased reliability of any method of examining the small bowel that challenges intestinal wall distensibility by fluid enteral volume infusion.

Contrast Media↗

PubMed2003

Classification of small bowel Crohn's subtypes based on multimodality imaging.

This article has reviewed the imaging features that correspond to and support the classification of patients into clinical subtypes of Crohn's disease. One study showed that radiologic features on barium studies closely correlated with the Crohn's Disease Activity Index, and another study indicated that CT findings changed patient management in up to 29% of cases. Knowledge of the location, severity, and presence of complications assist in providing patients with appropriate treatment options. Reports of radiologic studies in Crohn's disease should include the presence or absence of imaging features that support these different subtypes. An additional advantage of the use of a reproducible imaging classification that emphasizes morphologic features would be improved comparison of the results of different investigators and treatment protocols. Whatever method of radiologic investigation is employed, it should be targeted to answer questions relevant to patient management. The imaging modalities used should be able to classify the small bowel Crohn's subtypes and should be reflected in the radiologists' reports.

Barium Sulfate↗

PubMed2003

Dynamic evaluation of female pelvic organ prolapse by extended proctography.

More accurate preoperative assessment by DCP or MR imaging hopefully should reduce the incidence of operative failure. These techniques help the surgeon to plan the different components of pelvic reconstructive surgery and, importantly, whether a transvaginal or transabdominal approach will be required. The current trend is toward the transabdominal route. Available evidence suggests that the reoperative rate is halved when the abdominal approach is employed. Large enteroceles and marked vaginal vault prolapse, in particular, are much more amenable to correction by transabdominal surgery. It should be recognized that enteroceles and sigmoidoceles often escape preoperative detection unless radiologic evaluation is performed. Global assessment of pelvic organ prolapse is optimized by ensuring that competing organs are effectively emptied by virtue of a triphasic approach. As expressed succinctly by Halligan, "the global pelvic floor specialist has arrived, and his closest ally is the radiologist".

Barium Sulfate↗

PubMed2003

Technical refinements in enteroclysis.

As the primary method of investigating the small bowel, enteroclysis remains a technique in evolution. Technical refinements have made the examination faster to perform, better tolerated by patients, and easier to interpret. More recently, its essential principle of volume challenge has been combined with the tremendous advantage of CT cross-sectional imaging with multiplanar reformatting to give rise to the exciting new techniques of CT enteroclysis and MR enteroclysis (see separate reviews in this issue). Through improvements in methodology and advancements in technology, the future of enteroclysis looks bright indeed.

Contrast Media↗

PubMed2003

The multifaceted role of radiology in small bowel obstruction.

Small bowel obstruction is a common clinical condition, often presenting with signs and symptoms similar to those seen in other acute abdominal disorders. The diagnosis and treatment of this dynamic process continues to evolve. The imaging approach in the work-up of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this disease have undergone considerable changes over the past two decades. This article examines the changes related to the use of imaging technology in the diagnosis and management of patients with small bowel obstruction. The meaning of frequently used but poorly defined terms in describing intestinal obstruction is clarified and illustrated.

Contrast Media↗