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Biomedical subjects

R K Harned

Publications and source records attributed to R K Harned.

At least 19 recordsLinked to original sources
PubMed1997

Esophageal foreign bodies: safety and efficacy of Foley catheter extraction of coins.

OBJECTIVE: Continued controversy over the role of fluoroscopically guided Foley catheter removal of esophageal foreign bodies has limited the use of this technique despite its significant economic advantages. We reviewed our experience for the safety, efficacy, and applicability of this technique with pediatric patients who had swallowed coins. MATERIALS AND METHODS: We retrospectively reviewed 10 years of experience with pediatric patients who had undergone fluoroscopically guided Foley catheter removal of coins. All the pediatric patients with a suspected esophageal foreign body were first evaluated by plain film radiography. Foley catheter extraction was attempted when a radiopaque coin was seen and the patient lacked signs of significant esophageal edema resulting in tracheal compromise. During the 10 years covered by our review, 14 pediatric radiologists with specific training in the Foley catheter technique were involved in such removals. A separate review (of consecutive pediatric patients who had a history of or symptoms suggesting ingestion of a foreign body) focused on the percentage of these patients in which the Foley catheter technique was used. RESULTS: Of the 337 coin extractions attempted using a Foley catheter, coin extraction was successful in 322 (96%) of 337 patients. No complications were encountered. Our focused review found 422 consecutive patients who had undergone radiography to rule out foreign bodies. A radiopaque object was found in 249 (59%) of 422 patients. Of these 249 objects, 208 (84%) were ingested coins. Of 208 coins, 123 (59%) were retained in the esophagus; of these 123 coins retained in the esophagus, 116 (94%) were amenable to fluoroscopically guided Foley catheter extraction. CONCLUSION: Fluoroscopically guided Foley catheter extraction of retained coins in pediatric patients who lack evidence of significant esophageal edema causing tracheal compromise is a safe and efficacious technique. It should be considered the technique of choice for such extractions.

Catheterization↗
PubMed1996

Standard method of diagnosis versus use of a computer database in the evaluation of skeletal dysplasias.

OBJECTIVE: The objective of this study was to compare reference textbooks and the computer database, OSSUM, for accuracy and ease of use in the diagnosis of skeletal dysplasias. Materials and methods. Twenty cases of clinically and and radiologically established skeletal dysplasias were evaluated as unknowns by four pediatric radiologists. Readers 1 and 2 evaluated group A (10 cases) using reference texts and group B (10 cases) using OSSUM. Readers 3 and 4 evaluated group B using reference texts. The radiologists independently listed their roentgenographic findings, the top three diagnoses, confidence level, difficulty level, and time spent on each case. RESULTS: The correct diagnosis was made in 68% of both the reference text cases and the OSSUM cases. Difficulty level was significantly higher (3.5 vs 2.9, P = 0.0013) and confidence significantly lower (3.3 vs. 2.3, P = 0.0001) when using OSSUM. Average time spent on cases was 25 min with references and 30 min with OSSUM (P > 0.05). However, there was a decrease in both the time (38 min vs 23 min, P = 0.05) and the difficulty (3.9 vs 3.1, P = 0.001) between the first five and the last five cases. The composite of four readers correctly identified 90% of the skeletal dysplasias when the results of both methods were combined. CONCLUSIONS: In the ability to reach a correct diagnosis, no difference was detected between the OSSUM and reference texts methods. The increased time necessary, greater difficulty and decreased confidence levels with OSSUM are expected to improve with increasing program familiarity. Use of both textbooks and the database was complementary.

Bone Diseases, Developmental↗
PubMed1995

The hamartomatous polyposis syndromes: clinical and radiologic features.

Most radiologists are familiar with the clinical and radiologic features of the familial adenomatous polyposis syndromes [1]. The hamartomatous polyposis syndromes occur less frequently, however, and their radiologic and clinical manifestations are not as well known. This group of syndromes includes Peutz-Jeghers, multiple hamartoma, juvenile polyposis, Cronkhite-Canada, and Bannayan-Riley-Ruvalcaba. The predominant gastrointestinal lesion in these diseases is some form of hamartomatous polyp. The term hamartoma implies a nonneoplastic tumor or tumorlike condition composed of tissue elements normally present in the particular area [2]. In many of these syndromes, it is now recognized that hamartomatous polyps of the gastrointestinal tract coexist with adenomas and that adenomas may develop within hamartomatous polyps. Either situation may contribute to the frequent association of alimentary tract adenocarcinoma that occurs in most of these syndromes. Various types of benign mucocutaneous lesions are common and often lead to the correct diagnosis. Of greater importance is the frequent occurrence of other extraintestinal manifestations, including several forms of malignant disease. Because of this frequent association with both gastrointestinal and nongastrointestinal malignant tumors, early and accurate diagnosis of these syndromes is essential. Meticulously performed double contrast studies are the preferred radiologic procedures for the diagnosis of gastrointestinal polyps in all of these diseases.

Gastrointestinal Diseases↗
PubMed1994

Recurrent tumor after resection of hepatic metastases from colorectal carcinoma: location and time of discovery as determined by CT.

OBJECTIVE: Despite studies showing increased survival rates for patients after surgical resection of hepatic metastases, recurrences occur in 75% of treated patients. The purpose of this study was to determine the location and time of discovery of recurrent tumor on CT scans after resection of hepatic metastases from colorectal carcinoma. MATERIALS AND METHODS: In a 6-year period, 32 patients (16 men and 16 women) who had undergone partial hepatic resection for colorectal metastases had follow-up CT at our institution. A total of 125 CT examinations of the chest and abdomen were retrospectively reviewed for the presence and location of recurrent disease. Recurrence was either confirmed by biopsy (n = 12) or presumed on the basis of growth of new lesions (n = 17). RESULTS: With a mean follow-up of 22 months (range, 1-60 months), recurrence was found at 29 sites in 25 patients. Thirteen sites were hepatic, and 16 were extrahepatic. Three patients had both hepatic and pulmonary disease. Recurrence within the liver was away from surgical margins in 11 (85%) of 13 patients at 14 +/- 7 months and adjacent to a surgical margin in the remaining two patients (15%) at 17 +/- 1 months. Extrahepatic recurrences were discovered in the lung in 11 (69%) of 16 patients at 21 +/- 12 months; in an adrenal gland in two patients (13%) at 19 +/- 5 months; in lymph nodes of the porta hepatis in one patient (6%) at 11 months; at the primary colonic anastomosis in one patient (6%) at 3 months; and in a retroperitoneal lymph node in the remaining patient (6%) at 12 months. CONCLUSION: Surgery was effective in treating the preoperatively detected hepatic metastases. Only two of 25 patients had recurrence related to a hepatic surgical margin. Most recurrences occur more than 1 year after surgery, most often in lung or liver away from surgical margins, and they probably represent small metastases undetectable with current preoperative or intraoperative techniques.

Adenocarcinoma↗
PubMed1994

Characterization of swallowing and defecation in Parkinson's disease.

UNLABELLED: Despite the high prevalence of Parkinson's disease, the pathophysiology of its gastrointestinal symptoms remains poorly understood. OBJECTIVES: to evaluate swallowing and defecatory function in patients with Parkinson's disease and age- and sex-matched controls and to correlate objective findings with subjective symptoms. METHODS: The following studies were performed on 13 patients with Parkinson's disease and seven controls: extrapyramidal function assessment, gastrointestinal symptom survey, videoesophagram, colon transit study, defecography, and anorectal manometry. RESULTS: Abnormal salivation (frequency, %, control vs. Parkinson's disease: 14 vs. 77, p < 0.05), dysphagia (14 vs. 77, p < 0.05), constipation (14 vs. 31, p < 0.05), and defecatory dysfunction (29 vs. 77, p < 0.05) were more common among Parkinsonian patients. However, videoesophagographic abnormalities were equally common in both groups. Colon transit time was significantly prolonged in the Parkinson's disease group. Altered puborectalis function was noted on defecography in 31% of Parkinson's disease subjects, but in none of the controls (p < 0.05). Anorectal manometry identified several abnormalities in the Parkinson's disease group, which included decreased basal anal sphincter pressures, prominent phasic fluctuations on squeeze, and a hyper-contractile external sphincter response to the rectosphincteric reflex. Many patients exhibited both slow transit and manometric abnormalities, and symptoms were poor predictors of test results. CONCLUSION: In this group of patients with mild to moderate Parkinson's disease, videoesophagographic abnormalities were not confined to the patients with Parkinson's disease. Studies of colonic and anorectal function, in contrast, identified a number of abnormalities. Therefore, colonic and anorectal dysfunction appears to be an early gastrointestinal manifestation of Parkinson's disease, and may represent the direct involvement of the gut by this disease process.

Aged↗
PubMed1993

Defecatory function in Parkinson's disease: response to apomorphine.

We evaluated the effects of the dopaminergic agent apomorphine on defecation and anorectal function in patients with Parkinson's disease (PD). A gastrointestinal symptom survey, extrapyramidal assessment, defecating proctogram, and anorectal manometric study were performed in 8 subjects with PD. Basal studies showing abnormalities were repeated following apomorphine administration. Prior defecographic abnormalities were normalized following apomorphine injection in 1 of 3 subjects and significant improvements in manometric parameters were observed in all 5 subjects who underwent repeat anorectal manometry. We conclude that apomorphine can correct anorectal dysfunction in PD, and that these abnormalities may be a consequence of dopamine deficiency secondary to the PD process. These findings may also have therapeutic implications.

Aged↗
PubMed1992

Peutz-Jeghers syndrome.

The Peutz-Jeghers polyp is an unusual type of hamartomatous polyp; its characteristic feature is a smooth muscle core arising from the muscularis mucosae and extending into the polyp. Peutz-Jeghers polyps vary in size and shape; are found in the stomach, small bowel, and colon; and are usually multiple. Peutz-Jeghers syndrome is an inherited condition that often remains undiagnosed until after the polyps are identified, despite mucocutaneous pigmented lesions on the lips and mouth of children or young adults. In the past, standard therapy involved removal of the polyps that produced intussusception, but now endoscopic removal of all polyps is recommended. The polyps are not premalignant, but a definite association exists between Peutz-Jeghers syndrome and gastrointestinal carcinoma. Evidence shows that the syndrome is associated with an increased risk of extraintestinal malignancy, especially carcinomas of the pancreas, breast, and reproductive organs.

Adolescent↗
PubMed1992

CT during arterial portography: diagnostic pitfalls.

Computed tomography (CT) during arterial portography (CTAP) is an important technique for evaluating the liver before hepatic tumor resection. With this technique, most tumors are of low attenuation compared with that of enhancing parenchyma. At times, low-attenuation lesions are encountered that represent perfusion abnormalities rather than tumor deposits. These perfusion abnormalities can be categorized as (a) those resulting from improper technique; (b) those extending from hilum to capsule (straight-line sign), with or without an obstructing mass; (c) perihilar and periligamentous abnormalities; (d) subcapsular defects (linear or wedge shaped); and (e) those seen with cirrhosis or regenerating nodules. Adjuvant use of delayed CT, magnetic resonance imaging, and intraoperative ultrasound aids in characterization of these nontumorous defects, thereby improving specificity. The authors conclude that when potential candidates are evaluated for hepatic tumor resection, knowledge of the existence of the various diagnostic pitfalls of CTAP and their imaging characteristics is imperative to avoid inadvertent false results.

Angiography, Digital Subtraction↗
PubMed1992

Inflammatory fibroid polyps of the gastrointestinal tract: radiologic evaluation.

Inflammatory fibroid polyps (IFPs) are uncommon lesions of the gastrointestinal tract. Only scattered case reports have appeared in the radiology literature. The authors reviewed the cases of 33 patients (20 women and 13 men; average age, 45 years) to determine if these polyps had any distinctive diagnostic radiologic features. The IFPs were located in the stomach (n = 16), small bowel (n = 13), and colon (n = 4). The lesions originated in the submucosa and were composed of fibroblasts, inflammatory cells, and a network of blood vessels. Gastric IFPs were most often located in the antrum and were usually ulcerated. Most of the patients presented with clinical evidence of gastrointestinal blood loss. Small bowel polyps were usually located in the ileum, and patients were typically older women with intestinal obstruction due to intussusception. Most of the lesions appeared as large, intramural masses at radiologic examination. Some of the lesions were pedunculated, and all were solitary. There were no distinctive features to differentiate IFPs from other mural or intraluminal lesions of the gastrointestinal tract.

Colonic Neoplasms↗
PubMed1991

Extracolonic manifestations of the familial adenomatous polyposis syndromes.

The classic prototypes of the gastrointestinal polyposis syndromes are familial polyposis coli and Gardner syndrome. Extracolonic manifestations have been described in both diseases, and the distinction between them has become less clear. In fact, some authorities have suggested that familial polyposis coli and Gardner syndrome may represent a spectrum of the same disease. In both conditions, extracolonic expressions are the rule rather than the exception, and familiarity with them is essential for accurate diagnosis and correct patient management. In this pictorial essay, we discuss familial polyposis coli and Gardner syndrome together under the heading familial adenomatous polyposis syndromes. The colonic characteristics of these syndromes will be reviewed briefly, followed by examples of the most common extracolonic manifestations.

Adenomatous Polyposis Coli↗
PubMed1988

Development of squamous cell carcinoma of the esophagus after endoscopic variceal sclerotherapy.

We describe the case of a 45-yr-old white male with portal hypertension and presumed Laennec's cirrhosis who developed squamous cell carcinoma of the esophagus 8 months after completion of a course of endoscopic variceal sclerotherapy. The epidemiology and natural history of esophageal cancer and their relationship to our patient are analyzed. This report emphasizes that squamous cell carcinoma of the esophagus should be considered in the differential diagnosis of postsclerotherapy dysphagia. Further studies will be required to determine whether or not esophageal variceal sclerotherapy is associated coincidently or causally with the development of squamous cell carcinoma of the esophagus in patients at increased risk for this condition.

Carcinoma, Squamous Cell↗
PubMed1987

Hepatobiliary complications of inflammatory bowel disease.

A variety of biliary and hepatocellular diseases occur with increased incidence in patients with inflammatory bowel disease. These include fatty infiltration of the liver, cholelithiasis, pericholangitis-primary sclerosing cholangitis, cirrhosis, chronic active hepatitis, liver abscess, amyloidosis, granulomatous hepatitis, and bile duct carcinoma. Radiography is essential in accurate diagnosis.

Adult↗
PubMed1985

Clinical application of in vitro studies for barium-enema examination following colorectal biopsy.

A total of 150 colorectal biopsies were performed in 71 patients and correlated with the barium-enema examination (BE). The investigation was divided into two parts. In the first part, involving 19 patients, the depth of each biopsy specimen was determined histologically prior to BE and potential complications related to the biopsy-BE sequence were evaluated. In the second part, involving all 71 patients, the depth of biopsy specimens taken from various colon lesions was determined histologically without regard to the timing of BE. The results confirm previous in vitro findings in pigs and dogs, namely: (a) BE may be performed without delay following a superficial biopsy, but should not be performed until at least 6 days after a deep biopsy; (b) transcolonoscopic biopsies are likely to be superficial, while transproctoscopic biopsies have the potential to be deep; and (c) BE should be delayed at least 6 days following polypectomy or polyp biopsy performed with electrosurgery.

Barium Sulfate↗