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J C Lappas

Publications and source records attributed to J C Lappas.

18 recordsLinked to original sources
PubMed1992

Combined anorectal manometry and defecography in 50 consecutive adults with fecal incontinence.

Fifty consecutive patients presenting with fecal incontinence were evaluated prospectively with anorectal manometry, defecography, and other tests of anorectal function to assess the clinical utility of defecography in fecal incontinence. Leakage of contrast at rest and failure to narrow the anorectal angle with pelvic squeezing were specific but not sensitive predictors of decreased sphincter pressures as determined by manometry. Thus, after manometry, defecography provided no additional information regarding sphincter strength. Retention of contrast in large rectoceles or incomplete rectal evacuation at defecography had excellent correlation with the presence of clinical symptoms of outlet obstruction constipation (present concurrently with incontinence) and indicated an etiology of outlet obstruction symptoms. Defecography may provide useful information in incontinent patients with outlet obstruction constipation symptoms but has little additive value to anorectal manometry in incontinent patients without such symptoms.

Adult↗
PubMed1992

Selection of constipated patients as subtotal colectomy candidates.

We evaluated 224 consecutive patients referred for severe constipation prospectively by strict criteria to determine their candidacy for subtotal colectomy. Eighteen patients had insufficient symptoms to warrant evaluation. Two hundred six patients had anorectal manometry and defecography, and 182 had colonic transit measurement. Forty-nine patients had normal or minimally abnormal studies. One-hundred twenty-nine patients had abnormalities such as outlet obstruction, mild colonic inertia, diffuse gut dysfunction, or combinations of factors not favoring subtotal colectomy. Twenty-eight patients had colonic inertia without outlet obstruction and with disabling symptoms; 19 of these patients underwent subtotal colectomy. Follow-up > or = 12 months was available in 14 patients from this group. Of these patients, 12 (86%) were clinically improved. Preoperative evaluation accurately predicted postoperative fecal incontinence and likely reduced postoperative constipation. Small-bowel obstruction occurred postoperatively in 4 patients (29%), and remains a major risk of subtotal colectomy even in carefully selected candidates.

Adult↗
PubMed1992

Small bowel imaging.

Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. The mesenteric small intestine remains the only gastrointestinal tract segment for which diagnostic study is not principally dependent on endoscopic viewing. Because radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied. Barium contrast studies and enteroclysis, in particular, remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed to specific clinical circumstances that require discrete evaluation of the small bowel wall and adjacent tissues and organs.

Diagnostic Imaging↗
PubMed1991

Imaging of the small bowel.

Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. Except for the most proximal jejunal loop, which may occasionally be reached during upper gastrointestinal tract panendoscopy, and the terminal ileum, which can frequently be examined by the colonoscope, the mesenteric small intestine is the only gastrointestinal tract segment for which diagnostic study is not principally dependent upon endoscopic viewing. To the extent that radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied (Maglinte et al., Radiology 1987, 163:297-305). Barium contrast studies and enteroclysis in particular remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed toward specific clinical circumstances that require discrete evaluation of the small-bowel wall and the adjacent tissues and organs.

Humans↗
PubMed1991

Barium enema use in Indiana.

All 118 hospital-based radiology departments in Indiana responded to a survey of barium enema (BE) use. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE) for various indications, was similar to that reported for major medical centers around the world. The use of SCBE and DCBE did not differ between small and large hospitals or between hospitals in small versus large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema usually was performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Like major medical centers, there is no consensus regarding many issues in the performance of BE.

Barium Sulfate↗
PubMed1991

Radiographic evaluation of suspected small bowel obstruction.

Plain abdominal radiographs and enteroclysis studies were reviewed blindly in 117 consecutive patients undergoing enteroclysis for suspected small bowel obstruction. Plain radiographs were unreliably predictive of the presence of obstruction as determined by enteroclysis and surgery. Among patients with normal or abnormal nonspecific plain radiographs, varying degrees of small bowel obstruction were demonstrated by enteroclysis in 22%. Conversely, of patients with obstruction on plain radiographs, 42% had either normal enteroclysis studies or only minor adhesions. Enteroclysis correctly predicted the presence of obstruction in 100%, the absence of obstruction in 88%, the level (proximal vs distal) of obstruction in 89%, and the etiology of obstruction in 86% of operated patients. Enteroclysis is advocated as the definitive study in patients with clinical uncertainty about the diagnosis of small bowel obstruction.

Diagnosis, Differential↗
PubMed1990

Barium enema utilization within a defined geographic region: a survey.

All 118 hospital-based radiology departments in Indiana (USA) responded to a survey of barium enema (BE) utilization. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE), for various indications was similar to that reported for major medical centers around the world (RF Thoeni and AR Margulis, Radiology, 167: 7-12, 1988). The use of SCBE and DCBE did not differ between small and large hospitals, or between hospitals in small vs large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema was usually performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Also like major medical centers, there is no consensus regarding many issues in the performance of BE.

Barium↗
PubMed1990

Association of anterior ectopic anus and partial absence of levator musculature in a woman with impaired defecation. Report of a case.

A 25-year-old nulliparous woman with adult onset constipation and slight anterior displacement of the anus underwent pelvic magnetic resonance imaging and was diagnosed with congenital hemiabsence of the levator ani sling. Impaired defecation was confirmed by anorectal function studies and defecography demonstrated an anterior rectocele, perineal descent at the upper limit of normal, and partial obstruction of defecation, which appeared related to the levator sling abnormality. To our knowledge, this combination of findings has not been previously described as a cause of adult onset constipation.

Adult↗
PubMed1990

Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding.

A randomized, controlled trial was performed to compare the diagnostic yields and cost-effectiveness of two strategies for the evaluation of nonemergent lower gastrointestinal bleeding. Three hundred eighty patients aged greater than or equal to 40 yr were randomized to undergo initial flexible sigmoidoscopy plus air contrast barium enema or colonoscopy; 332 completed the initial studies. Initial colonoscopy detected more cases of polyps less than 9 mm in size, adenomas, and arteriovenous malformations but fewer cases of diverticulosis. No significant difference was found between strategies in the number of patients detected with cancers or polyps greater than or equal to 9 mm in size. In both strategies, cancers were more common in subjects aged greater than or equal to 55 yr (8% overall) than in those aged less than 55 yr (1%). Among patients aged less than 55 yr with suspected lower gastrointestinal bleeding, initial flexible sigmoidoscopy plus air contrast barium enema is a more cost-effective strategy for the detection of colonic neoplasms than initial colonoscopy. However, initial colonoscopy is more cost effective for those aged greater than or equal to 55 yr.

Barium Sulfate↗
PubMed1990

Enteroclysis--a technique for examining the small bowel.

Small bowel follow-through is the most commonly performed radiographic procedure for evaluation of the small bowel. However, recent advances in intubation and infusion techniques and the availability of improved barium suspensions have renewed interest in small bowel enteroclysis. Enteroclysis represents a significant improvement in the method of small bowel examination, yielding accurate diagnosis of a wide variety of lesions as well as confident demonstration of small bowel normality. Successful enteroclysis requires meticulous attention to technical and procedural details. The techniques of enteroclysis examination, diagnostic advantages, and clinical indications are elucidated in this review.

Barium Sulfate↗
PubMed1989

Enteroclysis in the evaluation of suspected small intestinal bleeding.

One hundred twenty-five consecutive enteroclysis studies performed for the indication of gastrointestinal bleeding were reviewed. The overall yield of positive studies was low (10%) but important lesions were found. Patients with unequivocally normal evaluations of the upper gastrointestinal tract and colon had the highest yield of positive enteroclysis studies (20%). Neither the specific type of bleeding, the presence or absence of abdominal symptoms or physical examination findings, nor the results of laboratory tests were associated with a positive or negative enteroclysis study.

Angiography↗
PubMed1989

Reliability of indications for cervical spine films in trauma patients.

Common emergency room practice mandates cervical spine (C-spine) films in all trauma patients with potential injuries. With the increasing costs of medical care, such liberal criteria may not be justified. This 1-year prospective study of 860 patients who presented to a Level I Trauma Center was undertaken to determine the signs and symptoms that would select the patients at risk of C-spine injury. The clinical presentation of each patient was correlated with the presence of C-spine fracture. Twenty-four patients (2.8%) had injuries demonstrated by plain film radiography. The incidence of fracture in 536 symptomatic patients was 4%. A significant likelihood of C-spine fracture was seen in patients with respiratory compromise (100%), motor dysfunction (54.5%), and altered sensorium (8.9%) (p less than 0.001). No fractures were seen in asymptomatic patients (p less than 0.001). Cervical spine radiography should be performed in patients with abnormal neurologic findings or symptoms referable to the neck. In alert asymptomatic patients, cervical spine radiography may be omitted.

Cervical Vertebrae↗
PubMedDate not supplied

Quality of air contrast barium enema performed the same day as incomplete colonoscopy with air insufflation.

The quality of 17 air contrast barium enemas performed the same day as incomplete colonoscopies using air insufflation was compared with 21 air contrast barium enemas performed on a different day from incomplete colonoscopies. A gastrointestinal radiologist blinded to the timing of the procedures reviewed the barium studies scoring them as 1 (unsatisfactory) to 4 (excellent) in four areas. The mean overall quality score for the air contrast barium enemas done the same day as incomplete colonoscopy was 3.29 vs. 2.97 for those done on a different day (p = 0.24). There were no significant differences in quality scores between same-day versus different-day air contrast barium enemas for the specific parameters of quality of distention, barium coating, and amount of spasm. We conclude that when colonoscopy using air insufflation is incomplete because of looping or angulation, air contrast barium enema can be done the same day without impairing the quality of the barium study.

Air↗
PubMedDate not supplied

Clinical utility of enteroclysis.

The incidence of pathology in the small bowel is substantially lower than in the upper gastrointestinal tract or colon. This is fortunate since the small bowel, with its unique anatomy and remote location is the most difficult section of the gastrointestinal tract to study. Instillation of contrast into the small bowel lumen can be achieved by the oral route or by the more recently refined technique of small bowel intubation/infusion called enteroclysis. This brief review will focus on the clinical infusion indications for and efficacy of enteroclysis and the relative advantages of enteroclysis over oral methods of small bowel radiography.

Crohn Disease↗
PubMedDate not supplied

Defecography: techniques for improved image quality.

Defecography is a radiographic study that demonstrates the physiological process involved when the rectum evacuates. Fluoroscopy, video recording and spot films are used to record the sequence of events that occur during defecation. Proper radiographic techniques and procedures must be used to demonstrate pathological conditions such as rectoceles, rectal intussusception and prolapse of the rectum.

Defecation↗