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Biomedical subjects

D D Maglinte

Publications and source records attributed to D D Maglinte.

At least 37 records · Page 2Linked to original sources
PubMed1995

Idiopathic localized dilatation of the ileum in adults: findings on barium studies.

OBJECTIVE: Idiopathic localized dilatation of the ileum is a rare entity characterized by a sharply demarcated segmental dilatation of the small bowel that is in line with the lumen. It is probably congenital in origin. Although more commonly diagnosed in children, it presents in adults as occult gastrointestinal (GI) bleeding or less often with abdominal pain. On pathologic examination, the mucosa may be ulcerated, but otherwise the wall is relatively normal. We analyzed the radiographic findings in nine previously unreported cases of this condition in adults. MATERIALS AND METHODS: Collaborative efforts resulted in the collection of nine cases from multiple institutions. In five cases, an enteroclysis had been performed; in three, a conventional small bowel series had been performed; and in one, the lesion was seen on a barium enema with reflux into the ileum. The mean age of patients was 52 years. In seven cases, pathologic correlation was available. In the other two patients, long-term clinical follow-up and repeat studies confirmed the diagnosis. Resected specimens showed a thin but otherwise normal wall with normal ganglion cells and nerve plexuses. Ulceration was noted in six of the seven resected cases. Two cases contained heterotopic gastric mucosa. GI bleeding and/or anemia was the most common (77%) presenting symptom. Abdominal pain and/or obstruction was present in slightly less than half the patients (44%). RESULTS: Lesions were 6-21 cm long and 4-13 cm wide, and all were located in the ileum. The dilated segments were bilobate in three cases, multilobate in three, spherical in two, and tubular in the other. The dilated area was always in line with the long axis of the bowel, not projecting to the side. No surrounding masses were seen. Except in three patients in whom ulcers were noted, the mucosa was normal. CONCLUSION: Idiopathic localized dilatation of the ileum should be suspected whenever a sharply demarcated area of lobulated small bowel dilatation is seen in a middle-aged patient with occult GI bleeding. The axial orientation distinguishes this condition from small bowel diverticula (including Meckel's). The lack of surrounding mass, mucosal irregularity, hypermotility, or fistulae help differentiate it from other causes of small bowel dilatation.

Adult↗
PubMed1995

Intravenous cholangiography and the management of choledocholithiasis prior to laparoscopic cholecystectomy.

The preoperative diagnosis of choledocholithiasis simplifies the laparoscopic management of biliary tract disease. Slow infusion intravenous cholangiography (SI-IVC) may be an accurate and cost-effective screening test for choledocholithiasis, and it is safer than traditional intravenous cholangiography. Forty-nine patients underwent SI-IVCs for suspected choledocholithiasis. These patients subsequently had endoscopic retrograde cholangiograms (ERC) or intraoperative cholangiograms (IOC) during laparoscopic cholecystectomies. Sixteen SI-IVCs demonstrated choledocholithiasis; 13 were confirmed by ERCs or by IOCs. The remaining 33 patients with negative SI-IVCs had negative ERCs or IOCs. The sensitivity, specificity, and accuracy of detecting choledocholithiasis by SI-IVC were 100%, 92%, and 94%. Only one patient had a mild reaction to the contrast agent. In our hospital the cost of an SI-IVC is $324, the cost of an IOC is $393 (including operating room and anesthesia costs), and the cost of an ERC is $1,085. SI-IVC is an accurate method of preoperative screening for choledocholithiasis. It is safe and cost-effective.

Adolescent↗
PubMed1994

Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders.

Patients with pelvic floor disorders frequently have associated anorectal dysfunction, which can be evaluated by a variety of laboratory tests. Evacuation proctography (defecography) documents the process of rectal evacuation and therefore demonstrates disorders of defecation, particularly those of an obstructive nature. It provides objective information about rectocele size and emptying and demonstrates coexistent enteroceles, many of which are missed on physical examination. This radiographic technique is the method of choice for recognizing rectal intussusception, the mechanism by which rectal prolapse occurs. Proctography suggests the diagnosis of spastic pelvic floor (anismus), a disorder amenable to biofeedback therapy. Proctography has limited application in anal incontinence unless there are associated obstructive symptoms. Evaluation of bladder dysfunction is aided by concomitant cystography. Gynecologists managing pelvic floor disorders should assess coexistent anorectal dysfunction, as undiagnosed enteroceles and disorders of defecation are an important cause of persistent or recurrent symptoms following pelvic floor repair. A comprehensive interdisciplinary approach to pelvic floor disorders is recommended.

Anal Canal↗
PubMed1993

Obstruction of the small intestine: accuracy and role of CT in diagnosis.

The reliability of abdominal computed tomography (CT) in the assessment of varying degrees of small bowel obstruction (SBO) was evaluated by using results at enteroclysis and clinical outcome as standards of reference. A blinded retrospective analysis was performed of the studies of 55 patients who underwent both CT and enteroclysis in the course of assessment for suspected SBO. Nine patients had no obstruction, 40 patients had obstruction due to adhesions, and six patients had tumor-related obstruction. CT results were used to identify correctly 63% (29 of 46) of those who had SBO and 78% (seven of nine) of the patients who did not. The overall accuracy of the CT interpretations to help establish diagnosis was 65% (36 of 55). When obstructions were classified into low- and high-grade partial obstruction, CT results could be used to identify correctly 81% (17 of 21) of high-grade SBOs and 48% (12 of 25) of low-grade SBOs. The procedure yielded two false-positive and 13 false-negative results for patients with low-grade obstruction, revealed masses in all six cases with tumor-related obstruction, and helped predict the correct cause in all true-positive cases.

Double-Blind Method↗
PubMed1992

Crohn disease of the small intestine: accuracy and relevance of enteroclysis.

The accuracy and clinical relevance of enteroclysis in the evaluation of 138 patients referred for enteroclysis for suspected Crohn disease of the small intestine are reported. The original prospective interpretations of enteroclysis results were assessed after a clinical follow-up period of 2 or more years. With all patients considered, enteroclysis had a sensitivity, specificity, and accuracy of 100%, 98.3%, and 99.3%, respectively, with only one false-positive diagnosis and no false-negative diagnoses. Thirty-one percent (n = 43) of the patients had lesions of early Crohn disease. All patients who required surgery (n = 23) had advanced lesions of the disease, according to enteroclysis criteria. Clinical evidence of Crohn disease did not develop in the 58 patients in whom enteroclysis revealed no abnormality. There were no complications related to the procedure. It is concluded that enteroclysis is an accurate method for diagnosis and exclusion of Crohn disease of the small intestine and provides detailed structural information relevant to appropriate management of the disease.

Adolescent↗
PubMed1992

Pelvic prolapse: assessment with evacuation proctography (defecography)

The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.

Adult↗
PubMed1992

Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.

Catheterization↗
PubMed1992

Evaluation of the small intestine by enteroclysis for Crohn's disease.

We reviewed the records of 100 consecutive patients referred for enteroclysis by gastroenterologists because of suspected Crohn's disease of the small bowel to assess the clinical utility of the information obtained by this method. More than one-third of the patients in the study group had subtle lesions of early Crohn's disease, all patients who required surgery had severe disease by radiologic criteria, and none of the 34 patients clinically suspected of having Crohn's disease of the small bowel in whom the enteroclysis was normal developed Crohn's disease in two or more years of clinical follow-up. Enteroclysis provides gastroenterologists with accurate and detailed structural information relevant to the appropriate management of the disease and in our hands is a reliable test for excluding Crohn's disease of the small bowel.

Adolescent↗
PubMed1991

Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients.

Initial observation and evaluation of patient progress have reduced the number of operative interventions in the management of small intestinal obstruction. The differentiation of simple mechanical from strangulating obstructions has remained difficult. Strangulation is not an invariable component of a closed loop obstruction. We report 27 patients with small bowel obstruction initially managed nonsurgically, in whom enteroclysis 2-8 days after admission demonstrated unsuspected closed loop obstruction. In 25 of the 27 patients, subsequent surgery confirmed the radiologic diagnosis: all the obstructed loops were viable and there was no operative mortality. Our experience suggests that the early performance of enteroclysis should be considered in patients with small bowel obstruction undergoing a trial of nonoperative management.

Adolescent↗
PubMed1991

Oral cholecystography in contemporary gallstone imaging: a review.

The introduction of nonoperative alternatives to elective cholecystectomy in the management of gallstones has resurrected use of oral cholecystography (OCG). This article reviews basic principles involved in the proper performance of OCG and interpretation of the resulting images. The role of OCG in the current management of gallstones is discussed.

Bile↗
PubMed1991

Radiologic features of closed loop obstruction: analysis of 25 confirmed cases.

The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.

Adolescent↗
PubMed1991

Gallstone imaging: getting the most out of the oral cholecystogram.

The introduction of "nonoperative" treatment alternatives to elective cholecystectomy (extracorporeal shock wave lithotripsy, contact dissolution of stones, and improved oral bile salts solvents) has reinstated the oral cholecystogram as an important diagnostic test providing structural and functional information on the status of the gallbladder. The basic principles involved in the proper performance and interpretation of the oral cholecystogram are reviewed from the perspective of the clinician who orders the test and makes management decisions based on its results.

Cholecystography↗
PubMed1991

Imaging of the small bowel.

Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. Except for the most proximal jejunal loop, which may occasionally be reached during upper gastrointestinal tract panendoscopy, and the terminal ileum, which can frequently be examined by the colonoscope, the mesenteric small intestine is the only gastrointestinal tract segment for which diagnostic study is not principally dependent upon endoscopic viewing. To the extent that radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied (Maglinte et al., Radiology 1987, 163:297-305). Barium contrast studies and enteroclysis in particular remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed toward specific clinical circumstances that require discrete evaluation of the small-bowel wall and the adjacent tissues and organs.

Humans↗