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Biomedical subjects

R E Clouse

Publications and source records attributed to R E Clouse.

At least 109 records · Page 6Linked to original sources
PubMed1986

Rhythmic spontaneous contractions in patients with esophageal symptoms.

Eight patients were identified over a 4-yr period with rhythmic spontaneous contractions of the esophagus. The contraction waves were found to originate immediately below the region of the upper esophageal sphincter in all patients, and propagated a short distance into the proximal esophagus. Mean interval between waves varied from 3.8 to 7.2 s, and all described patients had sequences of at least 5 repetitive waves. Contraction sequences were often initiated and terminated by swallows, but at other times occurred and ceased independent of swallows. Long periods of esophageal baseline pressure elevation were observed in the distal esophageal body, an indicator of poor esophageal clearance presumably related to the rhythmic contraction sequences. Half of the patients had endoscopic or radiographic evidence of reflux-related esophageal injury, yet dysphagia was the most commonly reported symptom. Concomitant manometric abnormalities of the esophageal body may have contributed to symptom production in several of the patients. This rare finding occurring singularly or in combination with other disorders may represent a symptomatic motility derangement that can be detected by systematic sampling of the entire esophagus during manometric examination.

Adult↗
PubMed1985

Variations in clinical presentation of patients with esophageal contraction abnormalities.

All patients referred over a one-year period for clinical esophageal manometry were asked to carefully characterize their esophageal symptoms on a self-report questionnaire. Seventy-five patients (48%) were found to have one or more of four contraction abnormalities in the distal esophagus which are thought to be associated with esophageal symptoms. Duration of any of the five symptoms sought (chest pain, dysphagia for solids, dysphagia for liquids, heartburn, regurgitation) varied from two weeks to 28 years (median two years). The prevalence of the individual esophageal symptoms was similar for each of the four contraction abnormalities. Chest pain was the most common symptom and did not vary in prevalence with the cumulative number of manometric abnormalities. In contrast, dysphagia for either liquids or solids tended to increase in prevalence with manometric severity. The variation in location of reported chest pain and dysphagia was remarkable. Although heartburn was reported as a presenting symptom by 48%, this symptom was reproduced by acid instillation in less than half of those so studied. We conclude that esophageal symptoms are generally poor predictors of manometric findings within this group and that variations in clinical presentation are common.

Deglutition Disorders↗
PubMed1985

Upper gastrointestinal bleeding in patients with chronic renal failure.

Endoscopy to evaluate upper gastrointestinal bleeding was done for 482 patients over a 42-month period. Fifty-nine patients (12%) had chronic renal failure and upper gastrointestinal bleeding; the remaining 423 did not have renal failure. Angiodysplasia of the stomach or duodenum was the most frequent source of bleeding in patients with renal failure. Angiodysplasia (p less than 0.001) and erosive esophagitis (p less than 0.01) were significantly commoner causes of bleeding in the renal failure population than in the group without renal failure. Recurrent bleeding was also more frequent in patients with renal failure (25%) than in the other patients (11%). Angiodysplasia was the most frequent source of recurrent bleeding in patients with renal failure (53%) whereas peptic lesions were the most likely sources in those without renal failure (51%). These data show that the differential diagnoses of first and subsequent upper gastrointestinal bleeding sites differ for patients with and without chronic renal failure.

Adult↗
PubMed1985

Angiodysplasia as a cause of upper gastrointestinal bleeding.

Angiodysplasia of the stomach, the proximal part of the small intestine, or both was diagnosed in 30 patients by upper gastrointestinal (Gl) endoscopy over a 40-month period. This diagnosis represented 4% of 676 patients referred over the same time period for endoscopic examination of suspected upper Gl bleeding. Twenty-three patients (77%) had experienced at least one episode of overt bleeding (hematemesis or melena) prior to diagnosis. Multiple gastroduodenal angiodysplastic lesions were found in 19 (63%) of the patients, and additional colonic angiodysplasia was detected in six of 12 patients who also underwent colonoscopy. Renal insufficiency was significantly more prevalent in the patients with angiodysplasia than in a comparison group of similar age with upper Gl bleeding from other lesions (60% v 24%). We conclude that angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper Gl bleeding. The lesion appears to be associated with renal insufficiency.

Adult↗
PubMed1985

Inaccurate values for direct bilirubin with some commonly used direct bilirubin procedures.

We compared five methods for the determination of total and direct bilirubins in serum samples from normal controls, subjects with Gilbert's syndrome, and serum pools containing about 50 and 150 mg of total bilirubin per liter. The Kodak Ektachem method and a diazotized sulfanilic acid method with 0.15 mmol/L sodium nitrite concentrations are the only methods that gave accurate direct bilirubin values, as judged by liquid-chromatographic results. The aca method that involved p-nitrobenzene diazonium tetrafluoroborate and another diazotized sulfanilic acid method with a higher concentration of sodium nitrite (0.8 mmol/L) yielded falsely high values for direct bilirubin, which could lead to clinical confusion. The more recently introduced diazotized sulfanilic acid method of the aca gave substantially better results than the p-nitrobenzene diazonium tetrafluoroborate method but was still inaccurate. Systematic investigation of these procedures revealed that the overestimation of direct bilirubin by the diazotized sulfanilic acid method was related to the amount of unconjugated bilirubin present and its ability to react as direct bilirubin in the presence of higher concentrations of sodium nitrite. Inherent properties of p-nitrobenzene diazonium tetrafluoroborate appeared to be responsible for inaccuracies in that method, which could not be corrected by varying reagent concentration or the reaction conditions.

Adult↗
PubMed1984

Surgical pathology of gastric and duodenal neuroendocrine tumors masquerading clinically as common polyps.

We report 12 cases of silent neuroendocrine neoplasms of the stomach and proximal duodenum masquerading clinically as common polyps. Five lesions were in the stomach, while seven were in the duodenum. Excision by endoscopic polypectomy usually did not remove all neoplastic tissue. The prognosis of these lesions is good even when the tumors are incompletely resected, although bleeding and secretory-product-related morbidity may precipitate surgery. Morphologic features by light or electron microscopy were not predictive of any given secretory product(s).

Adult↗
PubMed1983

Psychiatric illness and contraction abnormalities of the esophagus.

Over a six-month period 50 patients referred for clinical esophageal manometry were independently evaluated for psychiatric diagnoses to determine whether there was any association between psychiatric illness and esophageal motility disorders. The manometric studies were blindly classified according to findings in the esophageal body. Twenty-five patients were classified as having one or more of the following contraction abnormalities: an increase in mean wave amplitude, an increase in mean wave duration, an increased frequency of abnormal motor responses, or the presence of triple-peaked waves. Psychiatric diagnoses were made in 21 (84 per cent) of the 25 patients but in only 4 (31 per cent) of the 13 patients with normal manometric patterns (P less than 0.005) and 4 (33 per cent) of the 12 with other manometric abnormalities (P less than 0.01). The fact that psychiatric illness is associated with a specific cluster of esophageal contraction abnormalities may provide a basis for further investigation of the relation between emotional disturbances and disorders of gastrointestinal motility.

Adolescent↗
PubMed1983

Contraction abnormalities of the esophageal body in patients referred to manometry. A new approach to manometric classification.

A method is proposed for classifying conventional esophageal manometry findings according to the features observed in the esophageal body rather than the disease name. Patients who demonstrate increases in mean distal wave amplitude, mean distal wave duration, or number of abnormal motor responses (repetitive or simultaneous contractions) or the presence of triple-peaked waves are classified as having distal contraction abnormalities. Severity is scored by the cumulative number of these abnormalities. Of the 210 patients referred for esophageal manometry over a 23-month period, 119 (57%) were found to have one or more of the contraction abnormalities, making this the most common esophageal body manometric classification. The presence of one or two abnormalities was most common. Patients with all four abnormalities represented less than 5% of the referred population and, as a group, would satisfy usual manometric criteria for diffuse esophageal spasm. The proposed system allows for recognition of patients with only one or several of the manometric features typically seen in diffuse esophageal spasm and provides a method for intra- and interstudy comparison of patients with these common findings.

Adult↗
PubMed1983

Achalasia-like esophagus from amyloidosis. Successful treatment with pneumatic bag dilatation.

A 78-year-old man with amyloidosis involving the esophagus is described. The clinical and radiographic features resembled classic achalasia, while esophageal manometrics demonstrated aperistalsis, incomplete LES relaxation, but a normal LES resting pressure. A review of the literature suggests that esophageal amyloid may have variable presentations. This patient was successfully managed with forceful pneumatic bag dilatation.

Aged↗
PubMed1983

Manometric findings during spontaneous chest pain in patients with presumed esophageal "spasms".

Nine patients with intermittent chest pain thought clinically to be secondary to esophageal "spasms" developed typical pain while being studied with an intraluminal transducer probe placed in the distal esophagus. Manometric changes from control periods were examined preceding and during pain episodes. No significant difference in distal esophageal wave duration or amplitude or in frequency of abnormal peristalsis was observed preceding or during pain episodes when compared with nonpain periods over a mean monitoring time of 227 min. No change from the nonpain periods in esophageal baseline pressure occurred during pain episodes, nor was there any other obvious manometric change by gross inspection of the tracings. We conclude that patients clinically suspected of having esophageal "spasms" as the source of chest pain frequently do not, regardless of the presence or absence of motility abnormalities on conventional esophageal manometric studies.

Adult↗
PubMedDate not supplied

MR imaging of Crohn disease: use of perflubron as a gastrointestinal contrast agent.

This study was undertaken to evaluate the use of perflubron (perfluorooctylbromide) as an oral contrast agent for magnetic resonance (MR) imaging of patients with Crohn disease. MR examinations were performed before and after perflubron administration in 12 patients with documented Crohn disease. Glucagon was administered intramuscularly before the post-perflubron examinations. Each patient also underwent abdominal computed tomography within 48 hours of MR imaging. The imaging studies were analyzed for effectiveness of bowel marking with oral contrast agent, clarity bowel wall visualization, and presence of bowel wall thickening and extraluminal manifestations of Crohn disease such as abscess or fistula formation. Analysis of the imaging studies showed effective marking of the bowel with perflubron and improved bowel wall visualization on postcontrast MR images. Detection of bowel wall thickening and extraluminal complications of Crohn disease was not significantly improved on postcontrast MR images. The authors conclude that perflubron administration effectively marked the bowel and increased the clarity of bowel wall visualization but did not significantly increase the detection of abnormalities related to Crohn disease in the study population.

Adult↗
PubMedDate not supplied

Measurement of glucose in tracheobronchial secretions to detect aspiration of enteral feedings.

OBJECTIVES: To determine (1) the relationship between results from 2 methods to measure glucose in tracheobronchial aspirates, (2) the effect of blood glucose levels on tracheobronchial glucose levels, and (3) the relationship between results from 2 methods to measure glucose in selected enteral formulas. DESIGN: Descriptive. SETTING: Two midwestern acute-care hospitals, a research laboratory, and a clinical laboratory. PATIENTS: Sixty-two acutely ill adult subjects with artificial airways whose secretions required frequent suctioning for therapeutic purposes; 53 of these 62 patients also required capillary blood glucose measurements for therapeutic purposes. OUTCOME MEASURES: Glucose concentrations in tracheobronchial secretions, capillary blood, and selected enteral formulas. INTERVENTION: None. RESULTS: Measures of glucose content made on 75 split samples of tracheobronchial secretions by 2 methods (glucose oxidase reagent strips and a laboratory assay) were highly correlated (ri = 0.94; P < .001) and mean readings were not statistically different (P = .17). Sixty-six capillary blood glucose readings made within 5 minutes of tracheobronchal suctioning correlated poorly with the glucose content in the tracheobronchial aspirates (r = 0.12; P = .36). Glucose concentrations in 22 enteral formulas determined by 2 methods correlated highly (r = 0.95; P < .001). Glucose concentrations were higher with the laboratory assay (259.6 +/- 206.3 mg/dL) than with glucose oxidase reagent strips (188.6 +/- 157.5 mg/dL). CONCLUSION: It appears appropriate to use glucose oxidase reagent strips to estimate glucose concentrations in tracheobronchial fluid. Elevated blood glucose levels apparently do not have a major effect on the glucose content in tracheobronchial fluid. Although mean glucose concentrations in the 22 formulas were higher with the laboratory assay, the readings were sufficiently similar to allow using glucose oxidase reagent strips to give a good estimation of the formulas' glucose content.

Adult↗
PubMedDate not supplied

pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement.

BACKGROUND: Currently available bedside methods for determining feeding tube placement often provide inconclusive results. Therefore, additional data are needed to assist nurses in making decisions regarding tube location. OBJECTIVES: To describe the usual concentration of bilirubin in aspirates from newly inserted feeding tubes and to determine the extent to which these measures can contribute to pH alone in correctly predicting feeding tube location. METHODS: Gastrointestinal samples for concurrent pH and bilirubin testing were obtained from adult, acutely ill patients with newly inserted small-bore feeding tubes (nasogastric, n = 209; nasointestinal, n = 228) within 5 minutes of radiographs taken to determine tube location. Respiratory samples were tested (tracheobronchial, n = 126; pleural, n = 24). pH was measured with a pH meter, and bilirubin content was assayed spectrophotometrically. Results from the pH and bilirubin tests were compared with tube location as determined by radiography. RESULTS: Mean pH levels in the lung (7.73) and intestine (7.35) were significantly higher than the mean pH level in the stomach (3.90; p < .001 for each comparison). Mean bilirubin levels in the lung (.08 mg/dl) and stomach (1.28 mg/dl) were significantly lower than the mean bilirubin level in the intestine (12.73 mg/dl; p < .001 for each). By visually inspecting distribution overlap and mean differences by tube site, results were dichotomized so that a combination of pH and bilirubin values could be used to develop a predictive algorithm. A pH of >5 and a bilirubin value of <5 mg/dl correctly identified all respiratory cases, whereas a pH >5 coupled with a bilirubin level of > or =5 mg/dl correctly identified three fourths of the intestinal cases. A pH of < or =5 coupled with a bilirubin value of <5 correctly identified more than two thirds of the gastric cases. CONCLUSIONS: Preliminary laboratory-based data indicate that appropriate use of the proposed algorithm could significantly reduce the number of x-rays needed to exclude respiratory placement and to distinguish between gastric and intestinal placement.

Adolescent↗