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Biomedical subjects

D J Ott

Publications and source records attributed to D J Ott.

At least 73 records · Page 4Linked to original sources
PubMed1994

Specific acute colonic disorders.

This article reviews a variety of specific colonic disorders that may have been an acute clinical presentation. Less common causes of colonic obstruction include volvulus, intussusception, and hernias. Nonobstructive colonic dilatation is most often due to pseudo-obstructions and toxic megacolon. Several miscellaneous disorders discussed include colonic perforation, complications of leukemia that may affect the colon, and pseudomembranous colitis. The pathogenesis and clinical aspects of these disorders are reviewed, but the radiologic features are emphasized.

Acute Disease↗
PubMed1993

Achalasia associated with hiatal hernia: prevalence and potential implications.

Although hiatal hernia is reported with a 40-50% frequency in the general population, its occurrence and potential implications in achalasia are less well known. We reviewed the medical records and radiographic examinations of 120 patients with achalasia to assess the prevalence of hiatal hernia and its importance in evaluation and management of this motility disorder. Hiatal hernia was present in only 10 (8.3%) patients. Age, sex distribution, prevalence of dysphagia and regurgitation, and lower esophageal sphincter pressure measured manometrically were not significantly different in patients having hiatal hernia compared to those without hernia. Most patients (88%) underwent pneumatic dilatation and five esophageal perforations occurred, but all in patients without hiatal hernia. In conclusion, hiatal hernia is uncommon in patients with achalasia for reasons not known. Age, sex, symptoms, and results of esophageal manometry were not significantly different in those with hiatal hernia. Finally, the presence of hiatal hernia is not a contraindication to treatment of achalasia by pneumatic dilatation.

Adolescent↗
PubMed1993

Compression filming with high-density barium suspensions.

A method is described for use of high-density barium suspension (250% wt/vol) during compression filming performed in conjunction with the double-contrast examination of the stomach. The technique employs control of the distribution of barium within the stomach by table tilting and use of the vertebral column to stabilize the posterior wall of the stomach. The technique allows routine demonstration of the area gastricae and gastric erosions on compression films, as well as detection of anterior wall lesions that may be undetected by double-contrast films.

Barium Sulfate↗
PubMed1993

Clinical and videofluoroscopic evaluation of swallowing disorders.

Swallowing and feeding problems are common, particularly in elderly persons, and will be an increasing cause of disability as the geriatric population expands. Consequently, the need for clinical and radiologic examinations of patients who have swallowing problems will likely become commonplace. In this review, we define the problem confronting these patients, discuss the clinical and videofluoroscopic procedures used to examine patients with swallowing difficulty, and integrate the results of these examinations and their impact on feeding recommendations.

Deglutition↗
PubMed1993

Postoperative hysterosalpingography. Radiographic appearances and clinical results following tubal surgery.

Medical records and postoperative hysterosalpingograms on 23 women following tubal surgery who failed to become pregnant within 2-28 months were reviewed. A total of 39 tubes were analyzed. The surgical indications were reversal of tubal ligation in 24 tubes and correction of tubal or perifimbrial disease in 15 tubes. Tubal ligation had been performed by a variety of methods. At surgery, tubal patency, as shown by chromotubation, was seen in 37 (95%) of 39 tubes. On postoperative hysterosalpingography, tubal spillage was present in 32 (82%) of 39 tubes. Radiographically, the tubes that spilled appeared normal except for occasional shortening after reversal of tubal ligation. The eventual pregnancy rate was 8 (35%) of 23 patients, with 7 intrauterine. Pregnancy occurred only in women under 35 years and was more likely in the group having reversal of tubal ligation. We conclude that among patients who do not initially become pregnant following tubal surgery for infertility, tubal patency is restored in most. During hysterosalpingography, tubes operated on may appear normal or shortened. On long-term follow-up, younger patients and those requiring tubal anastomosis only had a higher pregnancy rate.

Adult↗
PubMed1993

Role of the barium enema in colorectal carcinoma.

Colorectal carcinoma is the second most common cancer that occurs in women and men. To better appreciate the role of the barium enema in the evaluation of colorectal carcinoma, an understanding of its epidemiology, pathologic development, and current methods of detection is needed. Following review of these aspects of colorectal carcinoma, the barium enema is discussed more thoroughly regarding examination techniques, radiologic evaluation of colonic neoplasms, quality of the examinations, and radiologic efficacy.

Barium Sulfate↗
PubMed1992

Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease.

Forty-one patients with neurologic disease (ND) were evaluated by clinical and videofluoroscopic examination of the oral cavity and pharynx to assess location and severity of swallowing dysfunction using various bolus consistencies. Four different materials were given to each patient, and included low- and high-viscosity barium suspensions, barium paste, and paste-coated cookie. Thirty-five patients had abnormalities of both oral and pharyngeal function. Four patients had pharyngeal dysfunction only, and two patients were normal. Mild swallowing difficulties occurred in five patients (12%), moderate dysfunction in 29 patients (71%), and severe dysfunction in five patients (12%). Thirty-two patients had pharyngeal stasis, which was symmetric in 30 patients (94%) and asymmetric in two. Site of stasis was not related to the type of neurologic disease. Fifteen patients aspirated, most of them (13 of 15) with the low-viscosity barium suspension. The predominance of aspiration with the low-viscosity liquid emphasizes the importance of clinical and videofluoroscopic evaluation of swallowing in dysphagic patients with ND for appropriate feeding recommendations. Thus, videofluoroscopy complemented the clinical examination and defined the type and severity of swallowing abnormalities and aspiration, when present.

Amyotrophic Lateral Sclerosis↗
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

Benign colorectal neoplasms undetected by colonoscopy.

This retrospective investigation assessed the sensitivity of colonoscopy for the detection of colonic polyps seen previously at barium enema examination. Included in the study were 77 patients with 106 polypoid lesions. Films showing lesions not subsequently seen at colonoscopy were reviewed and only those lesions with a visible point of attachment, exhibiting no movement in response to filling or change in position of the patient, and confidently diagnosed as a polyp by both reviewing radiologists were included among the 106 lesions. Sixteen lesions (15%) seen radiologically were not located colonoscopically, indicating an endoscopic sensitivity of 85%. Contrary to previous reports, most of the lesions missed endoscopically were in the left colon in regions thought to have been traversed by the instrument. The 15% false-negative rate found for colonoscopy is consistent with existing reports on colonoscopic errors and is approximately the same as the false-negative error rate for radiologic detection of colonic polyps.

Adult↗
PubMed1992

Gastroesophageal reflux disease: correlation of esophageal pH testing and radiographic findings.

In an attempt to ascertain radiologic efficacy in patients with evidence of gastroesophageal reflux disease (GERD) at pH testing, radiographic findings were correlated with pH values obtained with an esophageal monitor worn for a 24-hour period in 112 patients. Fifteen (30%) of 50 patients with abnormal pH test results had esophagitis diagnosed radiographically, compared with six (10%) of 62 with normal pH test results (P < .05). The severity of abnormal pH monitoring results was classified but did not correlate significantly with the prevalence of esophagitis diagnosed radiographically. Hiatal hernia was also more common (80% vs 60%) in patients with abnormal pH test results (40 of 50 patients) than in those with normal results (37 of 62 patients) (P < .05). Pharyngeal, laryngeal, and pulmonary symptoms were common indications for evaluation, and 14 of 27 (52%) patients with hoarseness had an abnormal pH tracing. Only a minority of patients with evidence of GERD as defined by abnormal pH test results had reflux esophagitis diagnosed radiographically.

Adolescent↗
PubMed1992

Interventional endoscopy of the biliary and pancreatic ducts: current indications and methods.

The use of interventional endoscopy of the biliary and pancreatic ducts has increased dramatically in recent years. Although choledocholithiasis is the most common reason for endoscopic treatment, other indications include pancreatolithiasis, cholangitis, biliary pancreatitis, papillary stenosis, sphincter of Oddi dysfunction, and benign or malignant ductal strictures. Endoscopic sphincterotomy is the cornerstone of therapeutic endoscopy and often precedes the use of balloon and basket stone extractors and placement of stents and endoprostheses. Other endoscopic methods include the use of lithotripsy, placement of drainage and infusion catheters, and coupling with percutaneous techniques. Radiologists need to be aware of the expanding indications and variety of endoscopic methods available for treating biliary and pancreatic disorders so that they can understand when the procedures are indicated.

Bile Duct Diseases↗
PubMed1991

Evaluation of the esophagus with a marshmallow bolus: clarifying the cause of dysphagia.

We reviewed the radiographic examinations of the esophagus and medical records in 117 patients (55 women and 62 men; mean age, 52 years) in which a marshmallow bolus was also given. A one-third to one-half piece of a standard marshmallow was used with a mean size of 23 mm (+/- 4.5 mm SD) measured in vivo. In 62 patients with no intrinsic structural narrowing of the esophagus, impaction occurred in only seven (11%). Four of these patients had an esophageal motility disorder, and three had a previous Nissen fundoplication. The remaining 55 patients had lower esophageal mucosal rings (47) or peptic strictures (8). Marshmallow impaction was seen in 27 of 47 rings (57%) and was inversely related to ring size, and in six of eight strictures (75%). Also, impaction was related to the ratio of bolus size to ring caliber, and invariably occurred when this ratio was greater than 1.5. Dysphagia was the presenting complaint in 76 (65%) patients, but was found equally in those without intrinsic narrowing and in those with ring or stricture. However, dysphagia was reproduced by the marshmallow bolus only in patients with esophageal narrowing or abnormal motility.

Candy↗
PubMed1991

Impact of the small bowel study on patient management.

Medical records of 528 consecutive patients who had a peroral small bowel examination or enteroclysis were reviewed. Clinical indications, efficacy of the small bowel examinations, and patient outcome were correlated to determine the impact of the small bowel examination on patient management. The most frequent indications were abdominal pain (19%), diarrhea (15%), obstruction (12%), bleeding (11%), postsurgical evaluation (10%), and assessment of Crohn's disease (8%). Two thirds of the studies (67%) were normal, and 33% of the examinations were abnormal, with similar results in all age groups. Small bowel obstruction (13%), miscellaneous results primarily including diffuse small bowel diseases (7%), adhesions (6%), and Crohn's disease (5%) were the most common abnormalities detected. The effects of small bowel studies on patient management were exclusion of serious pathology (67%), diagnosis that changed therapy (32%), and incidental findings (1%). Small bowel enteroclysis had a higher yield of positive examinations than the peroral small bowel examination, most likely due to patient selection.

Adolescent↗
PubMed1991

Radiographic evaluation of achalasia immediately after pneumatic dilatation with the Rigiflex dilator.

Radiographic evaluation of the lower esophagus was done immediately after pneumatic dilatation using the Rigiflex dilator in 34 patients (24 men, 10 women; mean age, 55 years) with achalasia. The dilator was positioned across the esophagogastic junction using fluoroscopy and the balloon was inflated for 1 min. The esophagus was intubated and injected sequentially with water-soluble and barium contrast materials. Radiographic analysis included changes in the appearance of the caliber and contour of the esophagogastric junction, rate of esophageal emptying, and presence of complications. In 23 patients with predilatation esophagrams, the mean esophagogastric junction caliber increased from 4.7-7.6 mm following dilatation. The postdilatation esophagrams in 33 patients showed a smooth contour in 22 (67%) and immediate esophageal emptying in 26 (79%). Esophageal perforation occurred in one (3%) patient and intramural hematoma in one (3%). Clinical follow-up (mean, 7 months) was available in 29 patients and 23 (79%) had symptomatic improvement. Five of the six patients who did not improve clinically all had previous Heller myotomy, pneumatic dilatation, or both.

Catheterization↗