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Biomedical subjects

D W Gelfand

Publications and source records attributed to D W Gelfand.

At least 73 records · Page 4Linked to original sources
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

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↗
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↗
PubMed1989

Effects of hiatal hernia, reflux esophagitis, and glucagon on the quality of double-contrast esophagram.

The possible effect of hiatal hernia, reflux esophagitis, and glucagon on the quality of the double-contrast esophagram was studied in 177 patients. Overall, the quality of the double-contrast esophageal views were judged poor in 46 (26%) patients and good in 131 (74%). No significant improvement in quality was evident in patients receiving glucagon, or in those with hiatal hernia or documented reflux esophagitis. Although the presence of gastroesophageal reflux or the lowering of esophageal sphincter pressure by glucagon would be expected to promote gaseous reflux from the stomach, no improvement in the quality of the double-contrast views of the esophagus was evident in our study.

Barium↗
PubMed1989

Diffuse esophageal spasm: radiographic and manometric correlation.

Diffuse esophageal spasm (DES) is characterized by substernal chest pain, dysphagia, and a manometric pattern of frequent simultaneous contractions with intermittently normal peristalsis. The authors correlated the radiographic and manometric findings in 17 patients with DES to better clarify the role of radiography in the evaluation of this uncommon motility disorder. Incomplete or absent primary peristalsis was observed on radiographs in 13 patients (76%), and mild to severe tertiary activity was seen in 12 patients (71%). The mean estimated thickness of the esophageal wall in patients with DES was 2.6 mm compared with 2.5 mm in an age-matched control group of 17 patients with normal esophageal manometric findings (P greater than .05). The authors conclude that most patients with DES show abnormal esophageal motility on radiographs, although the findings were nonspecific and required clinical and manometric correlation. Esophageal wall thickness was normal in patients with DES and appears to be an overemphasized sign in differentiating DES from other esophageal motility disorders.

Adult↗
PubMed1989

Esophageal motility: assessment with synchronous video tape fluoroscopy and manometry.

Synchronous video tape fluoroscopy and manometry of the esophagus was performed in 11 subjects (seven men and four women; mean age, 49 years). Four had normal and seven had abnormal esophageal motility (diffuse esophageal spasm, n = 4; nonspecific esophageal motility disorder, n = 3) that was shown by previous manometry. A digital timer appeared on the video tape recording and marked the manometric tracing synchronously. Alternate 5-mL and 10-mL barium boluses were recorded for a total of 10 swallows per patient. Video tape examinations were reviewed prospectively, and the status of primary peristalsis and presence and severity of tertiary activity were noted. A total of 98 swallows (58 normal, 40 abnormal) were correlated, and a 96% agreement was found in assessing primary peristalsis. Overall results of fluoroscopic examinations of each subject during all swallows showed complete agreement with those of manometry; segregating the swallows into groups of five showed 92% concordance. Severe tertiary activity was invariably seen with abnormal primary peristalsis at fluoroscopy.

Barium Sulfate↗
PubMed1989

Positive predictive value and posttest probability of diagnosis of colonic polyp on single- and double-contrast barium enema.

The positive predictive value for a radiographic diagnosis of colonic polyp, the prevalence of polypoid disease, and posttest probability relative to patient age were studied. The positive predictive value for colonic polyp on single- and double-contrast barium enema was determined for 191 polyps found radiographically in 136 patients who also underwent colonoscopy for confirmation. Of 72 polyps seen in 54 patients on single-contrast examination, 59 were confirmed endoscopically; 110 of 119 polyps seen in 82 patients on double-contrast examination were confirmed similarly, giving positive predictive values of 82% and 92%, respectively. Positive predictive values per patient, disregarding the number of polyps present, were 87% (47/54) and 90% (74/82) for the single- and double-contrast examinations, respectively. False-positive errors were due to stool, air bubbles, haustration, and misinterpretation of an appendiceal stump. By using specificities derived from our prevalence of polypoid disease and previously reported sensitivities, we drew posttest probability curves showing that predictive values depend both on the chance of disease before the test is done and on the efficacy of the test used.

Aged↗
PubMed1989

Barium enema examination: sensitivity in detecting colonic polyps and carcinomas.

We analyzed the sensitivity of the barium enema examination in 128 patients with 191 endoscopically proven colonic polyps and 12 carcinomas, relative to patient age, indications, and the type of examination used. Seventy-seven patients (60%) had rectal bleeding, and 51 (40%) patients with 87 lesions, including six carcinomas, did not. Overall roentgenographic sensitivity was 88%, with a 93% detection rate in patients less than 70 years old as compared to 76% for older patients. Sensitivity of single- and double-contrast barium enema examination was 82% and 91%, respectively. There were similar detection rates for lesions 1 cm or more in size (91% vs 95% for single- and double-contrast examinations, respectively), but double-contrast examination was slightly better at detecting smaller polyps (88%, vs 70% for single-contrast examination). Compared to colonoscopy, which has an average reported false-negative rate of 12% in detecting neoplasms, the barium enema is similarly reliable, less costly, and safer.

Adult↗
PubMed1989

The colon.

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Barium Sulfate↗
PubMed1988

Impact of the barium enema on patient management.

The medical records of 214 consecutive inpatients who had a barium enema examination were reviewed, and the clinical indications, efficacy of the barium enema, and patient outcome were correlated to determine the impact of the barium enema on patient management. The most frequent indications were rectal bleeding (33%), abdominal pain (31%), anemia (17%), weight loss (12%), and previous lesions needing reevaluation (12%). Diverticular disease (30%), colonic polyps (10%), and primary or secondary malignancies (12%) were the most common abnormalities detected radiographically. The sensitivity of the barium enema for colonic neoplasms was 89%, with only 1 small cecal polyp being undetected. The effects of barium enema on patient management were serious pathology excluded (64%), diagnosis made that changed therapy (24%), existing therapy continued (10%), and a further study ordered (2%). No serious or life-threatening lesion was missed by barium enema.

Barium Sulfate↗
PubMed1988

Progressive roentgenographic appearance of caustic esophagitis.

We observed progressive roentgenographic changes in five patients who had caustic esophagitis after accidental ingestion of a liquid alkali. Initial endoscopic examination showed moderate caustic esophagitis in all patients, and esophageal atony and poor distension were early roentgenographic observations. Esophageal strictures developed 13 to 44 days after caustic ingestion in all patients. Intramural pseudodiverticula complicated stricture formation in two patients. Esophageal diverticula developed in two cases, three months to one year after caustic ingestion. In summary, moderate caustic esophagitis is associated with esophageal dilatation, atony, and peristaltic abnormalities initially, and with eventual stricture formation.

Adult↗