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Biomedical subjects

D W Gelfand

Publications and source records attributed to D W Gelfand.

At least 145 records · Page 8Linked to original sources
PubMed1984

Tracheoesophageal fistula: a serious complication of infectious esophagitis.

Infections of the esophagus are common in individuals with altered immune status. A review of the literature reveals that, in such patients, fungal organisms, particularly Candida and Aspergillus, can invade deeply into esophageal muscle. We report the development of a tracheoesophageal fistula following polymicrobial infectious esophagitis. This case, of a young woman with leukemia, emphasizes the need for early recognition and aggressive treatment of esophageal infections.

Adult↗
PubMed1983

Predictive value of a diagnosis of colonic polyp on the double-contrast barium enema.

The positive predictive value of a diagnosis of colonic polyp on the double-contrast barium enema was determined by analyzing 160 polypoid lesions reported in 105 patients. Of the 160 polyps, 139 were confirmed by endoscopy, surgery, or repeat barium enema for a positive predictive value of 87%. Twenty-one lesions were not confirmed despite repeat endoscopy, repeat barium enema, review of the original study, or surgery, giving a false positive rate of 13%. The individual false positive error rates of 5 radiologists ranged from 8% to 26%. False positive errors were due to stool, diverticula, air bubbles, misinterpretation of the ileocecal valve, and haustration. Many of the false positive errors appeared to have been avoidable if the original examination had been more meticulously interpreted.

Adult↗
PubMed1983

Sensitivity of single-contrast radiology in esophageal disease: a study of 240 patients with endoscopically verified abnormality.

Single-contrast radiology of the esophagus was correlated with endoscopy in 240 patients with the following endoscopically verified abnormalities: esophagitis 170, rings 28, malignancies 19, varices 9, miscellaneous 14. For all the abnormalities except mild esophagitis, the overall sensitivity of the radiology in these 240 patients was 92%. All 19 cancers were diagnosed radiologically, whereas 90% of moderate and severe esophagitis was detected. The single-contrast examination thus reliably identified clinically significant disease of the esophagus. Comparison of these results to recent reports employing double-contrast technique suggests that claims of superiority for the double-contrast esophagram over the single-contrast study are not supported.

Adult↗
PubMed1983

Gastric perforation from hepatic artery infusion chemotherapy.

Hepatic artery infusion chemotherapy may result in mucosal inflammation and ulceration, gastrointestinal hemorrhage, pancreatitis and catheter-related vascular injury. We report a patient who developed gastric perforation during hepatic artery infusion chemotherapy. The influence of variations of hepatic artery branching and catheter placement in producing this life-threatening complication is discussed.

Catheterization↗
PubMed1983

Colon polyp morphology on double-contrast barium enema: its pathologic predictive value.

The morphologic appearance of 96 polyps seen on double-contrast barium enema was reviewed to assess the predictive value of various signs described to diagnose malignancy. Size, surface contour, basal indentation, and pedunculation were studied. Sessile polyps had an appreciable incidence of malignancy, with size being the best indicator of that risk. Pedunculation was found to be a reliable sign of benignity in predicting the absence of malignant invasion into the adjacent colonic wall. Polyps under 1 cm and having a smooth contour were invariably benign. Conversely, polyps larger than 1 cm with a lobulated contour and basal indentation had a significant incidence of malignancy.

Adenoma↗
PubMed1982

Declining volume of gastrointestinal fluoroscopies: a survey of 18 hospitals.

A survey of the volume of gastrointestinal fluoroscopies at 18 hospitals suggests a decline in the number of these examinations performed over the past 5 years. Data were acquired on 4 types of examinations: upper gastrointestinal series, small bowel studies, barium enemas (all types), and oral cholecystograms. Modest decreases of 8.4%, 10.3%, and 2.0% were noted in the numbers of upper gastrointestinal examinations, small bowel examinations, and barium enemas, respectively. A considerable decline of 45.9% was found in performance of oral cholecystograms. An overall decline of 14.4% was noted for all 4 examinations.

Barium Sulfate↗
PubMed1982

Radiologic detection and spectrum of appearances of peptic esophageal strictures.

We compared radiology and endoscopy in 80 patients with peptic esophageal stricture, with special attention to radiographic sensitivity for stricture caliber. Each stricture was classified by length into three types: 1) short (6-25 mm in length); 2) annular (under 6 mm in length); and 3) long (over 25 mm in length). Overall, radiology detected 95% of all strictures, including 90% of those over 1 cm in caliber. Morphologically, 75% of all strictures were short; 14% annular, and 11% long. Radiographically, smooth-stricture margins reliably excluded active esophagitis, while irregularity correlated well with its presence. Properly performed, barium esophagram can accurately detect esophageal strictures with a sensitivity approximating that of endoscopy.

Adult↗
PubMed1982

Extent of colonic visualization with the fiberoptic sigmoidoscope.

Forty-two patients underwent flexible sigmoidoscopy in the radiology department. After maximal insertion of the sigmoidoscope, a supine abdominal film documented the position of the tip of the instrument. Correlation with barium enema in all patients determined the extent of visualization of the colon relative to the length of insertion of the sigmoidoscope. Insertion to 60 cm was achieved in 31 (74%), 40-59 cm in six (14%), 25-39 cm in three (7%), and under 25 cm in two (5%), with a mean depth of insertion of 54 cm. Full insertion examined the entire sigmoid colon in 14 (45%) of 31 patients. Insertion between 40-59 cm achieved complete sigmoid evaluation in only one (17%) of six patients. Thus, flexible sigmoidoscopy does not necessarily guarantee evaluation of the entire sigmoid colon.

Adult↗
PubMed1982

The sensitivity of radiography of the postoperative stomach.

The results of radiology and endoscopy were compared in 140 patients who had undergone gastric surgery for ulcer disease. Of 74 patients who were examined with single-contrast radiography, 37 had abnormalities that were demonstrated endoscopically. The radiographic sensitivities in these patients were: gastritis 2/22 (9%); ulcer 3/5 (60%); obstruction 8/8 (100%); and miscellaneous abnormalities 2/2 (100%). The predictive accuracy of a diagnosis of ulcer was 38%. Of the 66 patients who were examined with double-contrast radiography, 33 abnormalities were found with endoscopy. The radiographic sensitivities were: gastritis 3/13 (23%); ulcer 7/10 (70%); obstruction 4/4 (100%); and miscellaneous abnormalities 6/6 (100%). The predictive accuracy of a diagnosis of ulcer was 44%. Radiology appears to be unreliable in diagnosing gastritis and recurrent ulceration in the postoperative stomach. The double-contrast technique does not offer significant improvement over the single-contrast method in evaluating these postoperative problems.

Barium Sulfate↗
PubMed1982

Sensitivity of single- vs. double-contrast radiology in erosive gastritis.

Radiologic sensitivity was determined in 54 patients with endoscopically diagnosed erosive gastritis. Four (24%) of 17 cases examined by single-contrast radiography and 16 (43%) of 37 cases examined by double-contrast radiography were detected. Double-contrast views and compression filming were both equally effective in diagnosing erosive gastritis during examinations where both were used. Although double-contrast examinations were more effective than single-contrast studies, both radiologic methods demonstrated poor sensitivity in detecting erosive gastritis.

Adult↗
PubMed1982

Barium sulfate suspensions: an evaluation of available products.

Commercially available barium sulfate suspensions were evaluated for suspension stability and coating characteristics important to the most commonly performed gastrointestinal examinations. Products tested included powders supplied in bulk, unit dose powders, and factory-prepared liquids. Results indicated considerable differences in suspension stability and coating properties among the products tested. Results also suggest that no single barium suspension currently available is likely to provide optimum performance during all of the more frequently performed studies.

Barium Sulfate↗
PubMed1982

Detection of gastric ulcer: comparison of single- and double-contrast examination.

The radiographic sensitivities of single- and double-contrast examinations for detecting gastric ulcer were compared. Single-contrast radiography detected 30 (75%) of 40 endoscopically verified gastric ulcers. Only 56% of ulcers under 5 mm were detected with the single-contrast method, while 88% of those larger were identified. Double-contrast radiography detected 58 (62%) of 93 endoscopically verified gastric ulcers. Only 45% of ulcers under 5 mm were detected with the double-contrast method, while 78% of those larger were identified. Statistically, the probability of ulcer detection was found to be primarily dependent on ulcer size, regardless of the technique used, and no significant difference could be demonstrated between the sensitivities of single- and double-contrast radiography.

Adult↗
PubMed1981

Reflux esophagitis revisited: prospective analysis of radiologic accuracy.

A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1 -- normal; grades 2, 3, and 4 -- mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patients with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patients with suspected reflux esophagitis are discussed.

Adult↗