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Biomedical subjects

W C Wu

Publications and source records attributed to W C Wu.

At least 145 records · Page 8Linked to original sources
PubMed1987

Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful?

Questionnaires were sent to 119 patients with noncardiac chest pain, all of whom had previous detailed esophageal evaluations in which 63 were diagnosed as having pain from the esophagus. Mean follow-up period was 21.8 months. Patients diagnosed as having an esophageal etiology of their noncardiac chest pain usually continued to have recurrent pain. Furthermore, a specific diagnosis did not significantly increase the likelihood of pain resolution. However, patients who understood that the esophagus was the source of their pain were significantly less likely to feel disabled by their pain and to require continued physician evaluation. This finding was independent of any treatment program. This study emphasizes the importance of a careful evaluation of the esophagus as a potential source of pain and clearly communicating this information to the patient.

Cardiac Catheterization↗
PubMed1986

Radiological evaluation of dysphagia.

Radiological examination evaluates both structural and functional abnormalities of the esophagus in patients with dysphagia. Combined with the clinical history, the radiological results can guide the clinician to a specific diagnosis, such as carcinoma or stricture, or to additional studies, such as endoscopy or esophageal manometry. Based on cost and diagnostic efficacy, the radiological method, compared with endoscopy, is most useful as the initial screening examination in patients with dysphagia (Table 2). Its major limitations are poor detection of mild cases of esophagitis and occasional lack of specificity in diagnosing esophageal motor dysfunction. To achieve these results, however, effective radiological evaluation of the esophagus requires the meticulous use of a combination of examining techniques.

Contrast Media↗
PubMed1986

Analysis of a multiphasic radiographic examination for detecting reflux esophagitis.

Radiographic and endoscopic findings were correlated in 46 normal patients and in 49 with reflux esophagitis to assess the efficacy of a multiphasic examination employing mucosal relief full-column, and double-contrast techniques. Esophagitis was graded endoscopically as mild, moderate, or severe, and the quality and sensitivity of each technique and of the examination as a whole were determined. The radiographic specificity in the normal patients was 98%. The overall sensitivity was 65% for all grades of esophagitis, and 90% for the moderate and severe grades. Sensitivities of the individual techniques were: mucosal relief: 43%; full-column: 53%; double-contrast: 45%. These differences were not statistically significant. We conclude that a combination of radiographic techniques is needed to detect reflux esophagitis optimally.

Esophageal Stenosis↗
PubMed1986

Ambulatory 24-hour esophageal pH monitoring. Technology searching for a clinical application.

The development of commercially available ambulatory 24 hour pH monitoring systems has expanded the potential use of this technique. In this article the use of these instruments is reviewed and direct comparisons between different techniques are made. Both the transnasal pH probes and the telemetric capsule have potential advantages and disadvantages for both the physician and the patient. Problems with the interpretation of pH recordings are discussed. A symptom index is developed in an attempt to provide a numerical assessment of the direct association between reflux events and symptoms in each individual patient.

Ambulatory Care↗
PubMed1986

Radiographic magnification of colon polyps.

Radiographic magnification was evaluated on conventional and remote control machinery using a phantom with steel rods positioned at different levels. Depending on the rod-film distance, the range of magnification was 8-47% on remote control and conventional overhead films and 11-82% on conventional fluoroscopic spot-films. Extrapolation to the colon based on cross-sectional anatomic correlation showed a 14-27% variation in the radiographic magnification depending on the machinery used, the segment of the colon considered, and the position of the patient. This implies that substantial inaccuracy in the measurement of colonic polyps is common by barium enema examination, particularly when a conventional fluoroscope is used.

Colonic Polyps↗
PubMed1986

Single-contrast vs double-contrast barium enema in the detection of colonic polyps.

Radiographic and colonoscopic correlation in 139 patients with 234 colonic polyps compared the sensitivity of single- and double-contrast barium enema. Single-contrast barium enema detected 68 (80%) of polyps, with 72% of polyps under 1 cm and 94% of those 1 cm or over detected. Double-contrast barium enema detected 135 (91%) of 149 polyps, with 88% of polyps under 1 cm and 96% of larger polyps detected. Thus, the double-contrast barium enema was more effective than the single-contrast examination only for detection of polyps under 1 cm. The single-contrast barium enema was more likely performed on patients in poor physical condition and in those over 70 years old. The results suggest that for elderly patients, who may have difficulty in cooperating for a double-contrast enema, a properly performed single-contrast examination is an acceptable option.

Adenoma↗
PubMed1986

Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring.

Radiographic and endoscopic sensitivities were compared in 60 patients with lower esophageal mucosal ring. Barium esophagram detected 57 (95%) rings, all shown by the prone full-column technique. Double-contrast technique in 39 patients demonstrated only 18 (46%) rings. Endoscopy detected 35 (58%) of 60 rings. Endoscopic sensitivity depended on ring caliber with detection of 18 (82%) of 22 rings 13 mm or less in caliber, 14 (54%) of 26 14-19 mm rings, and three (25%) of 12 rings 20 mm or wider. Dysphagia was present in 13 of 25 patients with rings undetected by endoscopy. The caliber of the fiberoptic instruments used also affected endoscopic detection, with 47% of the rings being diagnosed with narrower endoscopes and 76% being diagnosed with larger instruments. Thus, the radiographic examination was more accurate in detecting lower esophageal mucosal ring and should be used initially in patients with dysphagia and suspected lower esophageal narrowing.

Adult↗
PubMed1986

Radiologic and manometric correlation in "nutcracker esophagus".

"Nutcracker esophagus" is a newly described esophageal motor disorder seen in some patients with chest pain and/or dysphagia and characterized manometrically by normal primary peristalsis with distal contractions of high amplitude. The radiographic and manometric examinations in 20 patients with nutcracker esophagus were correlated. Normal primary peristalsis was observed radiographically in 16 patients, and a nonspecific motor disorder was diagnosed in the remaining four patients. Mild-to-severe nonspecific tertiary activity was seen in about half of the patients, esophageal wall thickness was normal. It is concluded that nutcracker esophagus is primarily a manometric diagnosis made in the appropriate clinical setting, and that the radiographic findings are normal or nonspecific.

Adult↗
PubMed1986

Radiographic efficacy in gastric ulcer: comparison of single-contrast and multiphasic examinations.

The efficacies of single-contrast and multiphasic examinations of the stomach for gastric ulcer detection were compared in 90 patients with 102 gastric ulcers, and in a control group of 382 patients without gastric ulcer. Single-contrast and multiphasic sensitivities were 62% and 64%, respectively. Radiographic detection depended significantly on ulcer size: Only 24% of ulcers under 5 mm were detected, compared with 89% of ulcers 5 mm or larger. Radiographic specificities and positive predictive values were similar for both types of examination. Moderate variation of the sensitivities and specificities of the three radiologists was observed, with ranges of 53-69% and 90-98%, respectively. Results indicated that gastric ulcer detection is more related to ulcer size and to individual interpretive variations than to the type of examination.

Adolescent↗
PubMed1986

Antral varices.

Varices of the gastric fundus, often associated with esophageal varices, are a common complication of portal hypertension or splenic vein occlusion. However, varices of the gastric antrum have been reported rarely. We describe a 61-yr-old man with antral and esophageal varices caused by portal hypertension due to hepatic cirrhosis.

Esophageal and Gastric Varices↗
PubMed1985

Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test?

Many years ago, it was proposed that the symptoms of heartburn correlated more closely with acid-induced esophageal motility abnormalities than with the presence of inflammation. This concept, however, has not been evaluated by modern manometric techniques. We monitored intraesophageal pressures during acid perfusion (O.1N hydrochloric acid) in 17 reflux patients with gross esophagitis and positive pain response and 17 age-matched controls. Using a low-compliance infusion system, amplitude, duration, velocity, and the presence of simultaneous and repetitive contractions in the body of the esophagus were evaluated. Amplitude did not change in either group. Duration did increase significantly during acid perfusion in reflux patients, but not in controls. Mean duration between groups, however, was similar before and during acid perfusion. No simultaneous contractions were observed, while three patients and two controls had repetitive contractions. A significant decrease in velocity was observed in both groups during acid perfusion. These studies indicate that acid-induced motor abnormalities are neither a common accompaniment nor necessary for the production of acid-induced pain in the esophagus.

Adult↗
PubMed1985

Predictive relationship of hiatal hernia to reflux esophagitis.

The relationship between hiatal hernia and reflux esophagitis was compared in 93 patients who underwent both radiographic and endoscopic examination of the esophagus. In 46 patients with a normal esophagus shown endoscopically, hiatal hernia was present in 59%, while 94% of 47 patients with reflux esophagitis had hiatal hernia. The positive and negative predictive values for hiatal hernia in diagnosing or excluding esophagitis were 62% and 86%, respectively. Extrapolation of these data and review of the literature suggest that much of the confusion concerning the relationship between hiatal hernia and reflux esophagitis is based on reports of populations with considerable variation in the prevalence of esophagitis and in which the radiographic criteria for diagnosing hiatal hernia have not been uniformly applied.

Esophagitis, Peptic↗
PubMed1985

Endoscopic sensitivity in the detection of esophageal strictures.

Endoscopy was compared in 90 patients with a radiographic diagnosis of peptic esophageal stricture. Retrospectively, 78 strictures were classified as valid diagnoses giving a positive radiographic predictive value of 87%. Endoscopy diagnosed 74 (95%) of the 78 peptic strictures, detecting all 45 strictures under 10 mm in caliber, but failing to detect four (12%) of 33 broader strictures. Nine (75%) of the 12 radiographic false-positive errors involved misinterpretation of muscular or mucosal rings of the lower esophagus. We conclude that endoscopy and radiology are equally effective and complementary methods for evaluating patients with suspected peptic stricture.

Esophageal Stenosis↗
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

Barrett esophagus as an extension of severe esophagitis: analysis of radiologic signs in 29 cases.

Twenty-nine cases of Barrett esophagus verified by endoscopy and 16 cases confirmed by histology were reviewed for pertinent radiologic signs. All patients had barium-filled and mucosal relief films, and all but five cases had double-contrast films. Common radiologic signs in descending order were thickened and irregular mucosal folds (28/29), hiatal hernia (26/29), esophageal stricture (25/29), esophageal ulcer (20/29), distal esophageal widening (19/29), granular mucosal pattern (16/24), reticular mucosal pattern (9/24), and intramural pseudodiverticula (6/29), all of which are also recognized signs of reflux esophagitis. Midesophageal stricture, esophageal ulcer, and distal esophageal widening were particularly indicative of Barrett esophagus. Since there appears to be no specific sign of Barrett esophagus, a multifaceted approach is suggested concentrating on the association of Barrett esophagus with the radiographic signs of severe reflux esophagitis.

Adolescent↗