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Biomedical subjects

D D Maglinte

Publications and source records attributed to D D Maglinte.

At least 55 records · Page 3Linked to original sources
PubMed1991

Factors in the diagnostic delays of small bowel malignancy.

The overall survival from primary malignancies of the small intestine has not changed over more than four decades. This generally is ascribed to delays in establishing the diagnosis and the advanced stage of the disease when treatment is begun. There has been no critical analysis of these delays. To answer these questions, we reviewed the records of all patients diagnosed with small bowel malignancy from 1967 to 1988 at the Methodist Hospital of Indiana. The onset and duration of symptoms, first medical consultation, time of performance of diagnostic procedures and surgery were verified in 77 patients with histologically confirmed small bowel malignancies. The longest delay occurs from the time medical help is sought to the time the diagnosis is made, not from the onset of symptoms to the first medical consultation. The small bowel should always be considered as a source of unexplained, persistent subtle abdominal symptoms.

Adult↗
PubMed1991

Barium enema use in Indiana.

All 118 hospital-based radiology departments in Indiana responded to a survey of barium enema (BE) use. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE) for various indications, was similar to that reported for major medical centers around the world. The use of SCBE and DCBE did not differ between small and large hospitals or between hospitals in small versus large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema usually was performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Like major medical centers, there is no consensus regarding many issues in the performance of BE.

Barium Sulfate↗
PubMed1991

Radiographic evaluation of suspected small bowel obstruction.

Plain abdominal radiographs and enteroclysis studies were reviewed blindly in 117 consecutive patients undergoing enteroclysis for suspected small bowel obstruction. Plain radiographs were unreliably predictive of the presence of obstruction as determined by enteroclysis and surgery. Among patients with normal or abnormal nonspecific plain radiographs, varying degrees of small bowel obstruction were demonstrated by enteroclysis in 22%. Conversely, of patients with obstruction on plain radiographs, 42% had either normal enteroclysis studies or only minor adhesions. Enteroclysis correctly predicted the presence of obstruction in 100%, the absence of obstruction in 88%, the level (proximal vs distal) of obstruction in 89%, and the etiology of obstruction in 86% of operated patients. Enteroclysis is advocated as the definitive study in patients with clinical uncertainty about the diagnosis of small bowel obstruction.

Diagnosis, Differential↗
PubMed1991

The role of the physician in the late diagnosis of primary malignant tumors of the small intestine.

Survival from primary malignancies of the small intestine has not improved during the last four decades. One reason for this is the advanced stage of disease at the time of surgery. In order to determine why diagnosis is made late, we reviewed the records of all patients with small bowel malignancy diagnosed between 1967 and 1988. The time from the onset of symptoms to the first medical contact and the time from medical contact until diagnosis were evaluated in 77 patients. The average delay in diagnosis attributable 1) to the patient failing to report symptoms was less than 2 months, 2) to the physician not ordering the appropriate diagnostic test was 8.2 months, and 3) to the radiologist failing to make the diagnosis was 12 months. Thus, the major delay in diagnosis was after medical help was sought and not from the onset of symptoms to first medical consultation. Physicians must increase their sensitivity to the subtle but persistent symptoms that necessitate a small bowel evaluation.

Adenocarcinoma↗
PubMed1990

Barium enema utilization within a defined geographic region: a survey.

All 118 hospital-based radiology departments in Indiana (USA) responded to a survey of barium enema (BE) utilization. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE), for various indications was similar to that reported for major medical centers around the world (RF Thoeni and AR Margulis, Radiology, 167: 7-12, 1988). The use of SCBE and DCBE did not differ between small and large hospitals, or between hospitals in small vs large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema was usually performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy. The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Also like major medical centers, there is no consensus regarding many issues in the performance of BE.

Barium↗
PubMed1990

Enteroclysis--a technique for examining the small bowel.

Small bowel follow-through is the most commonly performed radiographic procedure for evaluation of the small bowel. However, recent advances in intubation and infusion techniques and the availability of improved barium suspensions have renewed interest in small bowel enteroclysis. Enteroclysis represents a significant improvement in the method of small bowel examination, yielding accurate diagnosis of a wide variety of lesions as well as confident demonstration of small bowel normality. Successful enteroclysis requires meticulous attention to technical and procedural details. The techniques of enteroclysis examination, diagnostic advantages, and clinical indications are elucidated in this review.

Barium Sulfate↗
PubMed1990

Evaluation of swallowing disorders: the modified barium swallow.

Swallowing is a complex process. The diagnosis and treatment of swallowing dysfunction are more objective due mostly to recent research. The performance of a barium swallow, modified to study the dynamics of swallowing and its value in the management of patients with swallowing dysfunction, is described. The conventional barium swallow assesses structure and function of the thoracic esophagus, including gastroesophageal reflux and its sequelae. The modified barium swallow is a dynamic technique designed to evaluate swallowing function and dysfunction as it relates to the oral and pharyngeal phases of swallowing.

Barium Sulfate↗
PubMed1989

Enteroclysis in the evaluation of suspected small intestinal bleeding.

One hundred twenty-five consecutive enteroclysis studies performed for the indication of gastrointestinal bleeding were reviewed. The overall yield of positive studies was low (10%) but important lesions were found. Patients with unequivocally normal evaluations of the upper gastrointestinal tract and colon had the highest yield of positive enteroclysis studies (20%). Neither the specific type of bleeding, the presence or absence of abdominal symptoms or physical examination findings, nor the results of laboratory tests were associated with a positive or negative enteroclysis study.

Angiography↗
PubMed1989

Large colonic neoplasms missed by endoscopy.

Endoscopy is commonly accepted as the gold standard in the evaluation of neoplastic colonic disease. The procedure is used to confirm or exclude lesions detected on barium enemas, with the assumption that the endoscopist was successful in reaching the appropriate segment of the colon. We collected 18 cases, all with proved colonic neoplasm 2-8 cm in diameter that were detected by barium enema but overlooked on initial endoscopy. All of the lesions were relatively flat with little intraluminal protuberance. Histologic examination showed malignant foci in six of 11 tumors that were resected. In two of the other seven patients, unresected lesions progressed to advanced carcinomas. This experience suggests that a repeat barium enema is indicated when endoscopy fails to detect a colonic tumor suspected on barium enema examination.

Barium Sulfate↗
PubMed1989

Primary malignant tumors in the small bowel: a comparison of the small-bowel enema and conventional follow-through examination.

Of 71 patients diagnosed with primary mesenteric malignant tumors in the small bowel over a 21-year period in a community/teaching hospital, 14 underwent small-bowel follow-through, 16 underwent small-bowel enema (enteroclysis), and four patients underwent both studies preoperatively. In a retrospective study, the sensitivity of both the small-bowel enema and the conventional small-bowel follow-through examination were compared on the basis of the original radiologic interpretation. The studies were ordered by clinicians in a clinical setting. Results of the small-bowel follow-through were abnormal in 11 of 18 patients for a sensitivity of 61%, and small-bowel enema showed abnormalities in 19 of 20 patients for a sensitivity of 95% (p = .0165). The actual tumor was shown in six (33%) of 18 small-bowel follow-through studies and in 18 (90%) of 20 small-bowel enemas (p = .0005). In four patients, normal findings on conventional small-bowel follow-through were followed by abnormal findings on small-bowel enema done for the same reason. This experience suggests that the small-bowel enema is more sensitive than the conventional follow-through examination for the detection of small-bowel cancers.

Barium Sulfate↗
PubMed1988

Association of Meckel's diverticulum and Crohn's disease.

A significant association between Meckel's diverticulum and Crohn's disease has been suggested in the clinical literature. Ten patients with entities demonstrated radiographically as well as cases reported in the literature were analyzed to determine the relevance of this association to radiologic evaluation. The Meckel's diverticulum in most cases was an incidental finding whereas the Crohn's disease usually accounted for the patient's clinical symptoms. Recognition of this association should prevent unnecessary laparotomy for an incidental Meckel's diverticulum and improve the radiographic diagnosis of coexistent Crohn's disease.

Adult↗
PubMed1988

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis.

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large "chalky" and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.

Adolescent↗
PubMed1988

The laboratory response to glucagon dosages used in gastrointestinal examinations.

Laboratory studies occasionally are necessary for patients who have undergone hypotonic gastrointestinal examinations. To ascertain the effects of glucagon on these patients, we determined the biochemical and hematologic responses to doses of 0.25-2 mg of glucagon in a double-blind crossover study. When glucagon was given intravenously or intramuscularly in increasing doses, serum values for glucose and insulin increased linearly up to 1 mg with a slight decrease at 2 mg. After intravenous and intramuscular administration of glucagon, the white blood cell count and the percentage of neutrophiles and bands increased, and the percentage of lymphocytes decreased. Reports of side effects included one each of nausea and mouth dryness after intravenous glucagon and four reports of nausea and one of mouth dryness after intramuscular glucagon. No changes in the pulse and blood pressure could be attributed to glucagon administration.

Adult↗