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Biomedical subjects

R M Kerr

Publications and source records attributed to R M Kerr.

At least 19 recordsLinked to original sources
PubMed1992

Prevalence of upper gastrointestinal disease in relation to age: radiologic and clinical implications.

Reports of 1126 endoscopies were reviewed to determine the age-related prevalence of upper gastrointestinal (UGI) diseases as a guide to radiologists performing UGI examinations. Results indicate that (1) there were positive findings in 78% of all endoscopic examinations, and thus most symptomatic patients can be expected to have at least one UGI abnormality; (2) many patients with UGI symptoms have two or more reportable disease processes; (3) the prevalence of serious or life-threatening disease, such as cancer or large ulcers, rises steadily with age; and (4) after age 60, approximately 60% of symptomatic patients have a serious UGI disease. Based on these findings, radiologists should not hesitate to make the diagnosis of multiple abnormalities and should expect to diagnose at least one abnormality in most symptomatic patients having an UGI study. Also, because of the high prevalence of serious lesions in the elderly, endoscopy should be considered for the initial examination of an elderly patient if poor physical status would render the radiologic examination difficult or unreliable.

Adolescent↗
PubMed1992

A multicenter, double-blind, randomized, placebo-controlled comparison of nocturnal roxatidine in the treatment of active duodenal ulcer disease. Multicenter Roxatidine Cooperative Study Group.

This multicenter randomized, double-blind, 4-wk study compared the new H2-receptor antagonistic roxatidine (R) to placebo (P) for treatment of endoscopically diagnosed active duodenal ulcer disease. Subjects were evaluated after 2 and 4 wk of treatment. Those whose ulcer was unhealed at 2 wk received 2 more weeks of treatment before final evaluation. Ulcer healing (endoscopically determined) with roxatidine was more effective than placebo at both wk 0-2 (R = 33.9%, P = 21.9%, p = 0.018) and wk 2-4 (R = 68.2%, P = 29.7%, p less than 0.001), with an overall 4-wk effectiveness of 78.9% compared to 44.8% (p less than 0.001). At the end of treatment, average maximum ulcer diameter diminished 83% in R and 50% in P (p less than 0.001). Roxatidine was also more effective than placebo in decreasing abdominal pain (p less than 0.001), decreasing the number of antacid tablets taken for pain relief (p less than 0.001), improving dyspeptic symptoms (p less than 0.001), and permitting return to a normal routine for subjects with previous illness-imposed restrictions on work and/or other daily activities. The profile of laboratory values and adverse experiences demonstrated roxatidine to be safe and well-tolerated. The efficacy of roxatidine as evaluated by the healing rate of duodenal ulcer and reduction in abdominal pain emphasize its value as an addition to the family of H2-receptor antagonists.

Abdominal Pain↗
PubMed1991

Spinal MR imaging in suspected metastases: correlation with skeletal scintigraphy.

Bone scintigraphy (RN) and magnetic resonance imaging (MR) were prospectively and retrospectively correlated in 64 patients with suspected spinal metastatic disease and possible spinal cord compression. Images were retrospectively interpreted and compared with the prospective official RN and MR reports to help decide relative prospective lesion conspicuity. Spinal lesions were confirmed by radiography, computed tomography, myelography or MR and RN follow-up in 56 patients (88%). Prospectively, MR detected 11 lesions not reported on RN while RN detected two lesions not reported on MR. Retrospective review of RN detected six lesions previously not reported. Retrospectively MR showed all lesions. Those lesions seen only in retrospect by RN were rather subtle and would be difficult to detect prospectively. In general, lesions not well seen on RN had relatively more bone marrow abnormality and less cortical bone involvement. In some cases, MR imaging shows spinal marrow lesions not well seen on planar RN.

Adult↗
PubMed1990

Effects of liquid versus solid diet on colonic transit in humans. Evaluation by standard colonic transit scintigraphy.

The effects of liquid versus solid diet on human colonic transit were investigated, and transit following cecal instillation of tracer was compared with transit following instillation in the proximal jejunum. In a randomized cross-over, single-blind fashion, 6 normal volunteers ingesting either normal solid foods or a liquid diet were studied using colonic transit scintigraphy. 111In-DTPA was instilled either into the cecum via a long intestinal tube or into the proximal jejunum via a feeding tube. Compared with the liquid diet, the solid diet slowed transit in the cecum and ascending colon (p less than 0.025) and delayed progression of the geometric center (p less than 0.05) during the first 4 h of the study. Transit from 18 to 48 h was similar on the 2 diets. On the solid diet, transit was similar whether 111In-DTPA was instilled into the proximal jejunum or into the cecum. Transit from the terminal ileum to the cecum was assessed in an additional 5 volunteers following jejunal instillation of 99mTc-DTPA. Cecal filling was rapid (T1/2 = 0.49 h) and complete in all subjects before the onset of cecal emptying. These results suggest that colonic transit is slower on a solid than a liquid diet and that jejunal instillation of radiopharmaceuticals should be suitable for colonic transit studies in most subjects.

Adult↗
PubMed1989

Sonographically guided arthrocentesis of the hip.

High-resolution real-time sonography not only provides a noninvasive means of diagnosing hip effusions, but also provides easy access for arthrocentesis. Nineteen sonographically guided hip arthrocentesis were performed in 18 patients. In 13 of 19 patients aspirated, capsular distension was present. In 10 of 19 patients, fluid could be aspirated from the joint space (volume varying from 1 to 9 mL). Saline lavage was performed in 12 of the 19 joints needled. Intra-articular location was confirmed by observation during distension on real-time images or by successful aspiration. Sonographically guided arthrocentesis has potential advantages over conventional fluoroscopic techniques. These include a lack of ionizing radiation, superior visualization of needle location within the joint capsule, and the ability to diagnose soft tissue and periarticular abnormalities generally not seen fluoroscopically.

Biopsy, Needle↗
PubMed1987

Pneumatic dilatation of the achalasic esophagus requiring the aid of an endoscope.

We describe a 65-yr-old man with achalasia, who had two previous Heller myotomies. He had a markedly dilated, tortuous esophagus, which defeated initial attempts at pneumatic dilatation. A method was improvised in which a Brown-McHardy dilator was attached by a string to a small caliber endoscope and both were successfully passed into the stomach. Pneumatic dilatation was then easily performed. Review of the literature and our experience with four patients suggests that pneumatic dilatation can be performed without substantial risk in patients after a failed Heller myotomy.

Aged↗
PubMed1985

Duodenitis: endoscopic-radiologic correlation in 272 patients.

Potential radiologic findings of duodenitis were investigated in 272 patients, 157 with endoscopically diagnosed duodenitis and 115 endoscopically normal controls. The study assessed the value of four signs: folds more than 4 mm thick, mucosal nodules, bulbar deformity, and erosions. The most sensitive signs were thickened folds (72.0%) and nodularity (48.4%), while demonstration of erosions was the least sensitive (10.8%). Overall sensitivity (77.7%) approximated that for the radiologic diagnosis of peptic ulcer or esophagitis. Radiologic specificity (76.5%) was in the same range.

Adolescent↗
PubMed1985

Positive predictive value and examiner variability in diagnosing duodenal ulcer.

The positive predictive value of a diagnosis of duodenal ulcer was studied in 255 patients with 274 ulcers diagnosed radiographically. Retrospective analysis of the radiographic examinations and correlation with endoscopy assessed examiner variability, ulcer size, duodenal bulb deformity, and the confidence level of the ulcer diagnoses. For all diagnoses, the overall positive predictive value was 57% with individual predictive values of 47%, 54%, and 70% among three examiners. The individual predictive values correlated directly with the average level of confidence of the diagnoses for each examiner. The sensitivity of the individual examiner for ulcer detection had an inverse relation to the examiner's positive predictive value, confirming that higher sensitivities are achieved at the expense of an increased false-positive rate.

Duodenal Ulcer↗
PubMed1985

Infectious jejunitis with stricture after gastrojejunostomy.

Although bacterial overgrowth has often been reported in postgastrectomy patients, inflammatory stricture near the surgical anastomosis is rare. We describe a 36-year-old woman with infectious jejunitis and subsequent jejunal stenosis after gastrojejunostomy.

Adult↗
PubMed1979

Behavioral science and family practice: a status report.

The purpose of this study was to assess the current status of behavioral science instruction in family practice residency training programs. The primary areas of interest were: (1) characteristics of those who teach behavioral science (number of persons teaching behavioral science by discipline and academic degree, number and percent of time behavioral science personnel employed, work responsibilities, academic unit responsible for instruction, description of those who provide inservice training in behavioral science ), (2) the relative importance of various behavioral science topics as perceived by faculty/staff (21 topics), and (3) preferred methods of instruction. The data revealed a wide variety of persons involved in behavioral science instruction, a strong emphasis placed on communication and counseling skills, and similar, but not innovative, teaching methods used for behavioral science instruction.

Behavioral Sciences↗
PubMed1979

Secondary achalasia in esophagogastric carcinoma:re-emphasis of a difficult differential problem.

Six cases of esophagogastric junction carcinoma are reviewed, with emphasis placed on differential diagnosis between achalasia and carcinoma. All six had abnormal motility with aperistalsis being the most common finding. Three patients demonstrated tapering of the distal esophagus simulating achalasia. Patients over 40 with recent onset of esophageal symptoms and radiographic signs suggesting achalasia should be suspected of harboring carcinoma.

Adenocarcinoma↗
PubMed1967

Use of 125-I- and 51-Cr-labeled albumin for the measurement of gastrointestinal and total albumin catabolism.

A method for the simultaneous measurement of gastrointestinal protein loss and total albumin turnover entailing the use of a combination of (125)iodine- and (51)chromium-labeled albumin is described. Albumin turnover was calculated by the measurement of albumin-(125)I plasma decay and cumulative urinary excretion, and the results obtained agreed closely with previous studies utilizing albumin-(131)I. Gastrointestinal catabolism was calculated from the rate of fecal excretion of (51)Cr and the specific activity of plasma albumin-(51)Cr, and these data were related to the calculated albumin turnover results. During the period of 6-14 days after administration, the ratio of specific activties of albumin-(125)I and -(51)Cr in plasma and in extravascular spaces or gastric and biliary secretions remained almost identical. Fecal excretion of (51)Cr was also quite stable at this time. In six normal subjects gastrointestinal catabolism accounted for less than 10% of total albumin catabolism. Excessive gastrointestinal protein losses did not contribute to the low serum albumin in three patients with cirrhosis or in two adults with the nephrotic syndrome. Multiple mechanisms leading to hypoalbuminemia were demonstrated in other subjects with a variety of gastrointestinal disorders.

Albuminuria↗