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Biomedical subjects

R D Halpert

Publications and source records attributed to R D Halpert.

At least 37 records · Page 2Linked to original sources
PubMed1988

Evolution of the technologist specialist in gastrointestinal radiology.

Over the past few years, a program was initiated at the author's institution to train radiologic technologists to perform the fluoroscopic aspect of gastrointestinal examinations. The program was undertaken in an attempt to improve patient flow through the division, as well as in response to the decreasing number of residents being accepted into the radiology program. The results with respect to diagnostic quality of examination, improved patient flow, and patient and resident acceptance have been satisfactory.

Fluoroscopy↗
PubMed1987

Limiting overhead views in double-contrast colon examinations does not affect diagnostic accuracy.

A prospective study was undertaken to evaluate whether reducing overhead (technician-performed) films in double-contrast colon examinations had any effect on diagnostic accuracy. Only 4 overhead films were obtained routinely: supine, both decubitus, and prone cross-table rectal views. A high detect rate was maintained, comparable to our accuracy when 7 or 8 overhead films were obtained. Our study confirms that with double-contrast colon examinations, the need for overhead films is diminished. A significant decrease in cost, radiation exposure, and examination time can be obtained. We continued to use this method without any noticeable decrease in diagnostic accuracy.

Barium Sulfate↗
PubMed1987

Toxic dilatation of the colon.

Toxic dilatation of the colon represents the most serious complication of colonic inflammatory diseases. It is an acute transmural extension of severe inflammation resulting in decreased tissue cohesion and an increased tendency for bowel perforation. The process is characterized by dilatation and apparent radiologic thickening and nodularity of the bowel wall. Cases of toxic megacolon without dilatation occur infrequently.

Antidiarrheals↗
PubMed1986

Retrograde ileography: value of glucagon.

Many gastrointestinal diseases have a predilection for the terminal ileum. Retrograde ileography is a valuable technique for evaluating this region. However, this procedure necessitates reflux of barium (with or without air) into the terminal ileum. This does not often spontaneously occur during a barium enema study. The use of glucagon in double-contrast studies of the colon has been recommended for various reasons, one of which is to facilitate reflux of barium into the terminal ileum. This randomized, double-blind trial confirms that glucagon does promote reflux. Multiple regression analysis indicates that the independent variables of patient age, weight, and sex have little effect on the frequency of reflux. It is concluded that glucagon can facilitate examination of the distal small bowel during a double-contrast colon examination.

Female↗
PubMed1986

Reassessing the role of radiology in Hemoccult screening.

During a recent regional screening program, 98 patients with a positive Hemoccult test were evaluated radiographically. Double-contrast barium enema (DCBE) detected all six carcinomas and 92% of 37 polyps. DCBE was also the most cost-effective procedure. Colonoscopy dramatically increased screening costs without providing evidence to support its use in all Hemoccult-positive patients. It is recommended that DCBE be the initial diagnostic test in Hemoccult-positive patients, to be supplemented in selected patients by flexible sigmoidoscopy or colonoscopy depending on the pathology evident on DCBE and on clinical circumstances.

Adult↗
PubMed1985

Achalasia secondary to nongastrointestinal malignancies.

Secondary or "pseudo" achalasia of the esophagus can mimic idiopathic achalasia radiographically and can be difficult to diagnose. Typically, it is due to invasive carcinoma involving the gastroesophageal junction, usually gastric adenocarcinoma. Occasionally, an achalasialike condition can be produced by tumors not involving the gastroesophageal junction. We report 2 cases, 1 of lung carcinoma and the other of hepatoma, in which the patients had radiographic and endoscopic changes compatible with achalasia. However, the onset of symptoms was abrupt and the patients were elderly; these are unusual features for primary achalasia. There have been several other reports of nongastrointestinal neoplasms producing a clinical and radiographic picture similar to achalasia. Although there are several theories as to the cause, our cases would support the concept that direct tumor involvement of the gastroesophageal junction is not necessary to produce significant esophageal dysmotility.

Aged↗
PubMed1985

Radiographic abnormalities in eosinophilic esophagitis.

Eosinophilic gastroenteritis is an unusual condition of unknown cause in which there is eosinophilic infiltration of the gastrointestinal tract usually accompanied by a peripheral eosinophilia. Rarely, it can also involve the esophagus. Recently, the authors have encountered 3 cases of eosinophilic infiltration of the esophagus. All patients had a strong history of allergies. Two of our patients have had upper esophageal strictures, as have 2 other previously reported cases. This appears to be the most common manifestation. One patient had polypoid lesions of the esophagus as well as of the rest of the gastrointestinal tract. Motility disturbances may also be present. Although steroid treatment may be beneficial, the esophageal strictures usually require mechanical dilatation to relieve submucosal fibrosis. This entity should be considered in any patient who has an esophageal disorder in the presence of either a strong history of allergy or peripheral eosinophilia.

Adult↗
PubMed1985

Dysphagia in patients with gastric cancer and a normal esophagram.

Five patients presented with dysphagia but did not have abnormal esophageal motility or morphology on the esophagram. Each was found to have a malignant gastric tumor which did not appear to involve the gastroesophageal junction, and this was confirmed surgically in 2 cases. In 2 patients, diagnosis was delayed as a result of failure to examine the stomach following a normal esophagram. In the absence of abnormal esophageal motility, changes involving the gastroesophageal junction, or cerebral metastases, it is postulated that the dysphagia represented a nonspecific regional response to functional obstruction of the upper gastrointestinal tract secondary to an infiltrating neoplasm of the stomach. The fact that the esophagram was normal emphasizes the possibility that gastric lesions in patients with dysphagia may be missed when only a routine esophagram is employed. The authors recommend that the stomach be examined when no apparent cause for dysphagia can be discerned above the gastroesophageal junction.

Adenocarcinoma↗
PubMed1985

Distribution of colonic polyps: increased incidence of proximal lesions in older patients.

Several recent studies have shown a proximal shift in the distribution of colonic carcinoma compared to older studies. Because of the association between polyps and cancer, the authors evaluated the distribution of colonic polyps in 3,664 consecutive patients who had a colon examination over a period of 14 months. A total of 967 colorectal polyps were found in 633 patients. In all, 502 polyps (52%) were proximal to the rectosigmoid. Older patients had significantly more right-sided polyps and fewer rectosigmoid lesions. Large polyps occurred more frequently in the right colon, and this was also statistically significant. Gender has no effect on polyp distribution. The authors conclude that the importance of screening for polyps, particularly on the right side of the colon, increases with age.

Adult↗
PubMed1985

Gastric polyps: radiological evaluation and clinical significance.

Gastric polyps were found in 81 out of 4,692 consecutive radiological examinations (1.7%) and 103 out of 2,656 endoscopic examinations (3.9%) over a 19-month period. Polyps were more frequent in older patients and in women. Of 98 pathologically diagnosed lesions, 73 (74%) were hyperplastic and only two (2%) were adenomatous; most others were submucosal. Gastric polyps were rarely associated with carcinoma; only one patient had an area of severe dysplasia or carcinoma in situ, which was removed by polypectomy. The double-contrast technique had a high sensitivity and specificity in diagnosing gastric polyps. The location and number of lesions were relatively good indicators of pathology, but size and radiographic characteristics were not. The authors suggest that although radiology has a role in initial detection and screening, endoscopy should be the method of choice for further evaluation and follow-up. Histological identification is possible only with biopsy, and preferably polypectomy. The infrequent association with malignancy suggests that surgery is unnecessary in most cases.

Adenoma↗
PubMed1985

Crohn disease in the elderly.

During the past 2 years, we have encountered 14 patients whose onset of clinical symptoms of Crohn disease occurred after the age of 50, accounting for 14% of all Crohn disease patients studied in our department during this period. Most patients presented with diarrhea, abdominal pain, or perianal disease, and many also had anemia or rectal bleeding. The disease occurred slightly more often in the colon (n = 10), although many patients had terminal ileal disease (n = 7). The radiographic appearance was similar to that of Crohn disease in younger patients, with ulceration, fistula, and stricture formation. Occasionally, the disease mimics neoplasia or diverticulitis. Extraintestinal complications were also evident, with one patient each with renal calculi and ankylosing spondylitis. The occurrence of Crohn disease in the elderly is not uncommon, and a prompt diagnosis is important so that proper therapy can be initiated.

Abdomen↗
PubMed1985

Radiological assessment of dysphagia with endoscopic correlation.

Four hundred fifty consecutive patients with dysphagia were evaluated radiologically over a 14-month period; 127 of these (28.2%) were also examined endoscopically. The most common abnormality seen was dysmotility (34%), followed by hiatal hernia, benign stricture, and esophagitis. Correlation with endoscopy was generally good. Radiologic study demonstrated all cases of esophageal malignancy; radiologic/endoscopic correlation was also strong in patients with moderate or severe esophagitis, though the radiologist had some difficulty detecting mild inflammation. Endoscopy failed to demonstrate some benign strictures. Radiologic study was relatively accurate in detecting significant organic disease; most motility disorders were not detected by endoscopy. For these reasons, as well as lower cost, increased convenience, and patient comfort, radiologic assessment is recommended as the primary method of evaluating patients with dysphagia.

Adolescent↗
PubMed1985

A reappraisal of upper gastrointestinal response to low-dose glucagon.

Although glucagon is the most commonly used pharmacologic agent for gastrointestinal studies, its exact effects on upper gastrointestinal examinations have not been properly elucidated. A large study by our group did redemonstrate glucagon's significant effect on gastrointestinal motility. However, gastric distention and coating are not improved by glucagon, nor does it have a predictable effect on gastric emptying. Duodenal visualization does appear to be enhanced by the drug. Patient age, weight, and sex are not significant factors in glucagon's response, although they are variables that have an effect on UGI examinations. This article will review physiologic considerations in upper gastrointestinal examinations, with emphasis on glucagon's pharmacodynamics.

Age Factors↗
PubMed1984

A computer-based gastrointestinal information management system.

A clinical data base system was developed that integrates gastrointestinal radiologic examinations, endoscopic studies, and pathologic diagnoses. An interrogative language is used, so that data input occurs by response to a series of relevant questions and answers that are constructed by the clinical staff without programmer support. Data are stored in a hierarchical, natural-language (noncoded) format, making them easily understandable by all clinical groups. Since the computer system is interactive, there are on-line capabilities for data input at various times as well as for instantaneous retrieval of all data on a given patient. Retrieval (search) of data uses Boolean logic, allowing for intercorrelative studies among radiology, endoscopy, and pathology. Data can then be isolated in files in which the computer can generate demographic and statistical data by use of a series of programs. Both data search and analysis can be accomplished without programming knowledge. Not only are research functions served by the system, but educational functions such as preparation of conferences and lectures, professional quality assurance, and resident teaching through follow-up and missed-case review can be performed.

Computers↗