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Biomedical subjects

D J Ott

Publications and source records attributed to D J Ott.

At least 91 records · Page 5Linked to original sources
PubMed1991

Enteral feeding tubes: placement by using fluoroscopy and endoscopy.

Fluoroscopy and endoscopy are both effective for guiding placement of enteral feeding tubes, but the relative advantages and limitations of the two methods are less clear. Consequently, we studied 104 consecutive patients referred for primary fluoroscopic placement of a Frederick-Miller feeding catheter. Success rate, fluoroscopic and room times, and tube position were determined. Unsuccessful fluoroscopic placement was followed immediately by an endoscopic attempt. The success rate for fluoroscopic placement was 90% (94/104), with the tube placed into the jejunum in 53% and into the duodenum in 47%. The fluoroscopic and room times for successful fluoroscopic placements were 8.6 +/- 5.6 min (mean +/- SD) and 21.7 +/- 8.4 min, respectively. For the 10 unsuccessful placements, the fluoroscopic and room times were 16.2 +/- 5.4 min (mean +/- SD) and 45.6 +/- 18.4 min, respectively. Both time differences were significant statistically. Endoscopic placement was successful in all seven patients in whom it was attempted, with a mean time of 13.4 min. The tubes placed endoscopically were in the jejunum in 29% and in the duodenum in 71%. Our results show that fluoroscopic and endoscopic placement of enteral feeding tubes is highly effective. Fluoroscopic time in successful cases is usually less than 15 min. Endoscopic placement of feeding tubes is successful after fluoroscopic failure.

Adult↗
PubMed1991

Use of a marshmallow bolus for evaluating lower esophageal mucosal rings.

Sixty-three patients (35 women, 28 men; mean age 55 yr) with lower esophageal mucosal ring shown radiographically were examined with a semi-solid bolus consisting of a portion of a standard marshmallow. The most common symptom was dysphagia, present in 46 (73%) patients. Impaction of the marshmallow bolus by the ring occurred in 40 (63%) of the 63 patients, and produced symptoms in 27 (68%) of these 40 patients. Nine (14%) rings were detected radiographically only with a solid bolus; eight of these patients had dysphagia and seven rings were 20 mm or less in caliber. Impaction related to ring caliber, and was found in all 17 (100%) rings that were 13 mm or less in diameter, in 17/24 (71%) 14- to 19-mm rings, and in 6/22 (27%) rings 20 mm or more in caliber. Endoscopy in 23 patients detected 16 (70%) rings, and also depended on ring caliber: less than or equal to 13 mm, 6/6 (100%); 14-19 mm, 5/9 (56%); greater than or equal to 20 mm, 5/8 (63%). Marshmallow impaction occurred in 17 (74%) of 23 patients who had endoscopy; three of the 23 patients had normal endoscopy. In conclusion, radiographic examination supplemented by the use of a marshmallow bolus best detects lower esophageal mucosal ring.

Constriction, Pathologic↗
PubMed1990

Radiographic techniques and efficacy in evaluating esophageal dysphagia.

The radiographic examination of the esophagus to determine structural and/or functional causes of dysphagia is best performed with multiple techniques. These include full-column studies to produce distended films with or without the use of a solid bolus, mucosal relief films to identify mucosal defects such as esophagitis or the presence of varices, double-contrast films, and motion recording (fluoroscopy). The efficacy of each technique depends on the quality of the study and the specific disorder to be detected. Esophageal lesions producing dysphagia are classified into extrinsic structural lesions, intrinsic structural lesions, and esophageal motility disorders. Radiographic studies are the preferred screening techniques for patients with dysphagia. Although not as sensitive for the evaluation of mucosal lesions, radiographic studies are superior to endoscopy for the detection of abnormal motility, esophageal rings, and strictures.

Deglutition Disorders↗
PubMed1990

Effects of liquid versus solid diet on colonic transit in humans. Evaluation by standard colonic transit scintigraphy.

The effects of liquid versus solid diet on human colonic transit were investigated, and transit following cecal instillation of tracer was compared with transit following instillation in the proximal jejunum. In a randomized cross-over, single-blind fashion, 6 normal volunteers ingesting either normal solid foods or a liquid diet were studied using colonic transit scintigraphy. 111In-DTPA was instilled either into the cecum via a long intestinal tube or into the proximal jejunum via a feeding tube. Compared with the liquid diet, the solid diet slowed transit in the cecum and ascending colon (p less than 0.025) and delayed progression of the geometric center (p less than 0.05) during the first 4 h of the study. Transit from 18 to 48 h was similar on the 2 diets. On the solid diet, transit was similar whether 111In-DTPA was instilled into the proximal jejunum or into the cecum. Transit from the terminal ileum to the cecum was assessed in an additional 5 volunteers following jejunal instillation of 99mTc-DTPA. Cecal filling was rapid (T1/2 = 0.49 h) and complete in all subjects before the onset of cecal emptying. These results suggest that colonic transit is slower on a solid than a liquid diet and that jejunal instillation of radiopharmaceuticals should be suitable for colonic transit studies in most subjects.

Adult↗
PubMed1990

Impact and value of junior rotation in radiology.

All junior medical students at the authors' institution are enrolled in a 2-week combined rotation in diagnostic radiology and anesthesia, with the time divided equally between the departments. The purpose of this rotation is to familiarize students with various imaging modalities and to introduce interpretation of conventional radiographs. The rotation is offered five times during the academic year, and each includes the same enrollment (about 20 students), educational structure (lectures, self-study, and case review) and method of evaluation (multiple choice examination). To assess the educational benefits of this short exposure to radiology, we gave a preexamination and postexamination at the beginning and the end of each rotation. Comparison of scores between the pretest and post-test showed a significant learning gain for all rotations (P less than 0.01). There was no difference between groups scheduled early in the academic year compared with those with more clinical experience at the end of the year. We conclude that a well-structured brief junior rotation in radiology can effectively improve students' knowledge of imaging and its role in clinical evaluation.

Curriculum↗
PubMed1990

Oropharyngeal function study: radiologic means of evaluating swallowing difficulty.

The oropharyngeal function study is a videotaped radiographic examination of the oropharynx and cervical esophagus used in patients who are at major risk for aspiration because of swallowing difficulty. Preceding the radiographic evaluation, the patient is assessed clinically by a swallowing therapist who attends the examination with the radiologist. Close cooperation between the therapist and radiologist better defines the specific swallowing problems, avoids inadvertent aspiration of large amounts of contrast material, and best directs proper management of the patient. We describe our cooperative approach to evaluating oropharyngeal dysphagia.

Aged↗
PubMed1990

Oropharynx in patients with cerebrovascular disease: evaluation with videofluoroscopy.

Forty-six patients with cerebrovascular disease underwent videofluoroscopic examination of the oropharynx to assess location and severity of swallowing dysfunction with use of boluses of various consistencies. Low- and high-viscosity barium suspensions, a barium paste, and a paste-coated cookie were used; not all patients were given all materials. Thirty-nine patients had abnormalities of both oral and pharyngeal function. Two patients had oral dysfunction only, and five had pharyngeal abnormalities only. Mild swallowing difficulties occurred in 18 patients (39%), moderate dysfunction in 23 (50%), and severe dysfunction in five (11%). Thirty-one patients had pharyngeal stasis, which was symmetric in 25 patients (81%), right-sided in three, and left-sided in three. Asymmetric stasis did not correlate to the site of cerebrovascular disease. Twenty-four episodes of aspiration occurred, half of them with the low-viscosity barium suspension. Thus, video-fluoroscopy can be used to define the location and severity of oropharyngeal abnormalities, which is critical for feeding recommendations. The abnormalities present, however, were not useful in predicting the type of cerebrovascular disease.

Aged↗
PubMed1990

Update on esophageal radiology.

This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an intraluminal mass, mucosal irregularity, or asymmetric distensibility. Furthermore, barium studies may demonstrate lesions involving the valleculae, tongue base, lower hypopharynx, and pharyngoesophageal segment that are difficult to visualize at endoscopy. Double-contrast radiography is also a valuable technique for detecting opportunistic esophagitis and for differentiating the underlying causes. Mucosal plaques should suggest Candida esophagitis, whereas discrete ulcers should suggest herpes esophagitis, and one or more large, relatively flat ulcers should suggest cytomegalovirus esophagitis. Finally, in evaluating patients with chest pain, in only a small percentage are esophageal motility disorders found to be a possible cause of their pain. Instead, the majority are found to have cardiac disease, structural esophageal lesions, or gastroesophageal reflux, so that barium studies are more useful in documenting normal motility or structural abnormalities in these patients.

Esophageal Motility Disorders↗
PubMed1990

Radiologic evaluation of esophageal motility: results in 170 patients with chest pain.

The role of radiologic evaluation of esophageal motility in patients with chest pain has been studied rarely. Consequently, we compared the results of radiologic and manometric examinations of the esophagus in 170 patients (106 women, 64 men; mean age, 53 years) with chest pain. Manometry, used as the standard, was normal in 114 (67%) patients, and showed the following abnormal diagnoses in the remaining 56 (33%): nonspecific esophageal motility disorder in 27 (48%), nutcracker esophagus in 16 (29%), diffuse esophageal spasm in 11 (20%), and achalasia in two (4%). Radiologic specificity was 93% (106/114) and overall sensitivity only 36% (20/56). Sensitivity increased to 50% by excluding those with nutcracker esophagus, a purely manometric diagnosis. Of the 20 patients in whom nonspecific esophageal motility disorder and diffuse esophageal spasm were undetected on radiologic examination, minimal manometric criteria for diagnosis were available in 18. Our results show that radiologic recognition of normal esophageal peristalsis is excellent. However, the vast majority of patients with chest pain do not appear to have abnormal esophageal motility on radiologic evaluation.

Adult↗
PubMed1990

Manometry and radiology. Complementary studies in the assessment of esophageal motility disorders.

The relationship between radiological and manometric findings in esophageal motility disorders is poorly understood. Therefore, 20 subjects (4 normal; 13 diffuse spasm; 3 other motility disorders) were studied using synchronous manometry and videofluoroscopy with alternate 5-ml and 10-ml barium swallows. A total of 181 swallows were analyzed. Concordance between manometry and fluoroscopy was excellent for individual swallows (98%), groups of 5 swallows (97%), and final diagnoses (90%). Contraction onset intervals less than 0.8 s apart over 5 cm (velocity greater than 6.25 cm/s) were critical in determining abnormal bolus transit (98% sensitivity and positive predictive value). Radiologically, segmental tertiary activity (complete luminal obliteration) was always associated with disrupted primary peristalsis, but nonsegmental tertiary activity was often seen with normal bolus transit and did not have a specific manometric correlate. Four patterns of interrupted peristalsis radiologically were found--segmental tertiary contractions, a generalized esophageal contraction, absence of motor activity, or discoordinated "to-and-fro" movement. Surprisingly, nearly complete barium clearance occurred by the first two mechanisms in two thirds of swallows. Thus, the authors believe radiology and manometry are both excellent studies for identifying abnormal esophageal peristalsis. In difficult cases, these tests give complementary information because radiology assesses bolus movement while manometry provides quantitative pressure data.

Barium Sulfate↗
PubMed1989

Radiographic and manometric correlation in achalasia with apparent relaxation of the lower esophageal sphincter.

We compared the clinical, radiographic, and manometric findings in 10 patients with atypical achalasia showing complete lower esophageal sphincter (LES) relaxation to 39 patients with classic achalasia (i.e., incomplete LES relaxation). Those with atypical achalasia were younger (46.1 vs 60.6 years), had dysphagia of shorter duration (18.7 vs 45.7 mos), had lost less weight (8.2 vs 21.5 lbs), and had less esophageal dilatation (2.8 vs 3.9 cm). However, the mean LES pressures (34.5 vs 37.7 mmHg) and the esophagogastric junction calibers (4.5 vs 4.8 mm) were similar. Radionuclide esophageal emptying studies were done in 15 patients (6 with atypical achalasia; 9 with classic achalasia) and were abnormal in all. Most patients in both groups (90 and 92%) responded well to pneumatic dilatation. We conclude that achalasia with apparent LES relaxation may represent an early form of this motor disorder and that the radiographic findings remain characteristic except for less dilatation of the esophagus.

Adult↗