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Biomedical subjects

W J Ravich

Publications and source records attributed to W J Ravich.

31 records · Page 2Linked to original sources
PubMed1990

Esophageal motility in an adult with a congenital H-type tracheoesophageal fistula.

Congenital H-type tracheoesophageal fistulas (TEF) are rare. Long-standing respiratory symptoms are the most common presenting complaints. Patients with these fistulas have a congenital esophageal motor abnormality characterized by uncoordinated, low-amplitude peristalsis of the esophageal body; both low and normal lower esophageal sphincter pressures have been described. These findings persist despite fistula repair. A case history of an adult patient with congenital TEF is presented and the literature is reviewed. This patient is unusual in that esophageal symptoms (dysphagia) were more prominent than the usual respiratory symptoms.

Adult↗
PubMed1989

Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention.

Intrapulmonary placement of small-bore nasogastric feeding tubes caused pneumothoraces in four patients. Review of the literature discloses another 106 cases of the same complication. Risk factors for intrapulmonary complications include endotracheal intubation or tracheostomy (60% of reported cases [95% confidence interval, 44% to 80%]), and altered mental status (36% of reported cases [95% confidence interval, 24% to 53%]). We propose a simple, two-step method of feeding tube insertion designed to prevent such complications in high-risk patients.

Aged↗
PubMed1989

Psychogenic dysphagia and globus: reevaluation of 23 patients.

Despite warnings against attributing dysphagia to psychological causes, the diagnoses of "psychogenic dysphagia" or "globus hystericus" have been previously applied to 13% of patients referred to the Johns Hopkins Swallowing Center. This paper reports the results of reevaluation of 23 patients previously diagnosed as having symptoms of psychogenic origin. The Swallowing Center evaluation documented an explanation for symptoms in 15 (65%). No cause of dysphagia could be documented in eight patients. All five patients with the "globus sensation" had a documentable abnormality of swallowing. Overall, nine patients had esophageal pathology, while six had pharyngeal disease. Five had structural lesions constricting the lumen, while 10 had motor dysfunction of either the pharynx or esophagus. Review of the referral records of these patients indicates the quality of prior evaluation for patients previously labeled as having a swallowing disorder of psychogenic origin is variable, and that once attribution of symptoms to psychogenic causes is made, the diagnosis is rarely reconsidered. We conclude that attribution of the diagnosis of psychogenic dysphagia should be made with caution, and only after thorough evaluation. Any change or progression of symptoms should prompt a careful re-evaluation.

Adolescent↗
PubMed1987

Granular small bowel mucosa: a reflection of villous abnormality.

Diffuse mucosal granularity was reported recently in small bowel Crohn's disease. The radiographic appearance corresponded on histopathologic examination to villous hypertrophy, fusion, or epithelial bridge formation. We have observed similar granularity in Crohn's disease but also in several other conditions, including radiation enteritis, pancreatic glucagonoma, protein-losing enteropathy, and small bowel ischemia. Histopathologic examination demonstrated various alterations in villous morphology, such as edema, hyperplasia, clubbing, or fusion. In Crohn's disease, this appearance was sometimes an indication of early inflammatory disease but was also seen following extensive small bowel resection, possibly due to villous enlargement resulting from intestinal adaptation. These findings suggest that granular mucosa in the small bowel is a nonspecific finding reflecting an alteration in villous structure.

Adult↗
PubMed1985

Pharyngoesophageal interrelationships: observations and working concepts.

Simultaneous disorders of the pharynx and esophagus are so frequent that the complete swallowing chain should be examined in all patients with dysphagia. Data are presented to support the concept that such simultaneous disorders represent related phenomena; the mechanism involves changes in cricopharyngeal function seen radiographically as cricopharyngeal prominence. If neurologic disease has been excluded, cricopharyngeal prominence may be the clue to esophageal disease. When cricopharyngeal prominence is found during dynamic imaging of the pharynx, intensive examination of the esophagus and a search for signs of compensation or decompensation in the pharynx should be undertaken.

Cineradiography↗
PubMed1985

The Swallowing Center: concepts and procedures.

This paper describes the purpose and organization of a dedicated center at The Johns Hopkins Medical Institutions for the evaluation of swallowing problems. The multidisciplinary approach outlined will permit a better understanding and more accurate diagnosis of the functional or organic lesions affecting the swallowing mechanisms. Illustrative cases are presented.

Adult↗
PubMed1984

Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal reflux.

A 56-yr-old man with severe reflux esophagitis, Barrett's esophagus, and a peptic lower esophageal stricture underwent subtotal resection of the Barrett's esophagus with colonic interposition. After the interposition procedure, gastroesophageal reflux was eliminated, as evidenced by absence of clinical and radiographic findings and by the results of a later continuous pH probe recording. Despite the absence of reflux, 8 yr after the colonic interposition the patient was found to have adenocarcinoma in the remnant of the Barrett's esophagus. This case indicates that elimination of gastroesophageal reflux does not necessarily lead to regression of Barrett's mucosa, nor does it prevent development of adenocarcinoma. As a result, patients with Barrett's esophagus should remain under long-term surveillance for dysplasia and adenocarcinoma, even after successful antireflux therapy. If esophagectomy is performed, every attempt should be made to resect all of the esophagus lined by Barrett's mucosa.

Adenocarcinoma↗
PubMed1983

Fructose: incomplete intestinal absorption in humans.

Fructose is an increasingly important commercial sweetener. However, some patients report abdominal symptoms after ingesting fructose-containing foods. The completeness of fructose absorption by the small intestine was assessed by breath hydrogen analysis in 16 healthy volunteers and incomplete absorption was defined as a peak rise in breath hydrogen of greater than 20 parts per million. Fructose, 50 g as a 10% solution, was incompletely absorbed in 6 of 16 subjects (37.5%). Incomplete absorption was associated with symptoms of cramps or diarrhea, or both in 5 of these 6 individuals. Incomplete absorption was both concentration- and dose-related. Three subjects incompletely absorbed 37.5 g of fructose. In comparison, all 15 subjects who were studied after ingestion of sucrose, 50 g and a 10% solution, completely absorbed this sugar load. Incomplete absorption of fructose should be considered as a possible case of gastrointestinal symptoms.

Adult↗