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Biomedical subjects

E T Stewart

Publications and source records attributed to E T Stewart.

At least 37 records · Page 2Linked to original sources
PubMed1990

Gastrointestinal lipomas: a radiologic and pathologic review.

Lipomas of the gastrointestinal tract are an infrequent finding on radiologic examination; however, they occur often enough to warrant consideration in the differential diagnosis of mass lesions of the gut. In many instances, their morphologic characteristics allow the specific diagnosis of a lipoma. In this report, we review gastrointestinal lipomas with an emphasis on their radiologic and pathologic correlation.

Gastrointestinal Neoplasms↗
PubMed1989

Alimentary tract lesions in Cowden's disease.

Cowden's disease was first recognized by its striking dermatological manifestations and subsequently by the increased incidence of neoplastic involvement of the thyroid and breast. Two cases of Cowden's disease with gastrointestinal polyps are presented to illustrate the alimentary tract involvement in this syndrome, gastrointestinal tract involvement with polyposis being seen in at least 50% of cases. As opposed to the more serious potential of neoplasia in the thyroid and breast, involvement of the alimentary tract has negligible clinical impact to the patient.

Adult↗
PubMed1989

Choledochal cyst: findings on cholangiopancreatography with emphasis on ectasia of the common channel.

Choledochal cyst is a congenital malformation of the biliary tree that is unusual but by no means rare. During a 13-year period, we encountered eight patients with choledochal cysts who were evaluated with cholangiopancreatography. All of our cases showed an anomalous union of the pancreatic duct and common bile duct, resulting in a long common channel. Review of cholangiopancreatograms also showed ectasia of the common channel in six of the eight patients. Mean length of the common channel, corrected for magnification, was 26 mm (normal, less than 15 mm). The mean corrected diameter of the common channel was 7 mm (normal, 3-5 mm). We conclude that ectasia of the common channel is an important additional radiographic observation in the diagnosis of choledochal cyst. This observation has not been emphasized before.

Adolescent↗
PubMed1989

Tipper and dipper types of oral swallows.

We characterized the normal patterns relating to the onset of the oral-swallowing phase in patients with normal oral motor function. The main pattern of swallowing was of the tipper type, in which swallowing is initiated with the tip of the tongue against the incisors and the bolus is in a supralingual position. However, a second pattern of a dipper-type swallow occurred, in which part of the bolus initially is positioned beneath the anterior part of the tongue. This circumstance requires that the tongue dip beneath the bolus in order to elevate the bolus above the tongue. Dipper swallows occurred in all age groups, but were more prevalent in subjects 60 years or older. Recognition of this component in normal swallowing patterns is essential for optimal evaluation of normal subjects and patients with an abnormal oral phase of swallowing.

Barium Sulfate↗
PubMed1988

Efficacy of quantitative hepatobiliary scintigraphy and fatty-meal sonography for evaluating patients with suspected partial common duct obstruction.

In this study we evaluated by blinded design the diagnostic efficacy of two noninvasive techniques, quantitative hepatobiliary scintigraphy (QHS) and fatty-meal sonography (FMS), for evaluating patients with suspected partial common duct obstruction. Quantitative hepatobiliary scintigraphy was performed on 56 cholecystectomized individuals (22 asymptomatic controls, 28 patients with suspected partial common duct obstruction, and 6 nonjaundiced cirrhotics) and FMS was done in 51 cases. For QHS, time-activity curves were generated for regions of interest over the liver, hepatic hilum, and common duct. For FMS, we measured common duct diameter before and 45 min after a fatty meal (Lipomul, 1.5 ml/kg). Each of the 28 patients with suspected partial common duct obstruction and 6 cirrhotic patients underwent endoscopic retrograde cholangiography, often accompanied by sphincter of Oddi manometry. Findings from these examinations were taken as the gold standard to determine the presence or absence of conditions that could account for intermittent symptomatic partial common duct obstruction. The most sensitive indicators for a positive test were a 45-min isotope clearance of less than 63% for QHS and a common duct increase of greater than or equal to 2 mm after the fatty meal for FMS. Of 28 patients with suspected partial common duct obstruction, 15 were judged to be true-positive and 13 true-negative. The 6 cirrhotic patients were without common duct obstruction. The study findings showed that each test had a 67% sensitivity that improved to 80% when the findings from both test results were combined. The specificity of QHS was 85% and that of FMS was 100%. All 6 cirrhotic patients had negative findings on FMS and 4 were false-positive on QHS. The true-positives included 8 patients with a small common duct stone and 6 with obstructive sphincter of Oddi dysfunction (4 stenosis, 2 dyskinesia). We conclude that noninvasive QHS and FMS afford good sensitivity and specificity for evaluating cholecystectomized patients with suspected partial common duct obstruction.

Adult↗
PubMed1988

Computed tomography examination of periampullary neoplasms.

The hospital records of 24 patients with periampullary neoplasms were reviewed. The clinical triad of jaundice, pain, and weight loss and the radiographic imaging triad of dilated biliary ducts, dilated pancreatic duct, and periampullary mass should suggest the diagnosis of periampullary neoplasm.

Adenocarcinoma↗
PubMed1988

Influence of bolus volume on swallow-induced hyoid movement in normal subjects.

Swallowing normally elicits a superior-anterior excursion of the hyoid that contributes to elevation of the larynx and opening of the upper esophageal sphincter. The magnitude of hyoid movements, however, has not been quantitated with respect to the volume of the swallowed bolus. In this study, we determined the magnitude of superior and anterior movements of the hyoid associated with swallows of barium of different volumes. Lateral videoradiographic images of 2- to 20-ml boluses of barium were obtained in 15 subjects who had no pharyngoesophageal symptoms and had normal pharyngoesophageal motor function. Analysis indicated that a significant direct correlation existed between the volume of the swallowed bolus and the magnitude of the superior and anterior movements of the hyoid. For example, the mean values for these respective movements were 13.0 +/- 5 mm and 13.5 +/- 6 mm for a 2-ml bolus, compared with 14.8 +/- 5 mm and 16.7 +/- 5 mm for a 10-ml bolus. The findings indicate that values of deglutitive movement of the hyoid need to be indexed to the volume of the swallowed bolus. The results imply that the neural program in the brainstem that generates the oral and pharyngeal phases of swallowing is not completely stereotyped, but rather is modulated by volume-dependent sensory feedback.

Adult↗
PubMed1988

Roscoe Miller award. Fatty-meal sonography for evaluating patients with suspected partial common duct obstruction.

We evaluated the efficacy of fatty-meal sonography for identifying patients with partial common duct obstruction. The test consisted of initial control measurements of common duct diameter followed by repeated measurements every 15 min for 60 min after a fatty meal consisting of Lipomul (1.5 ml/lb). The rationale proposed for the fatty-meal test is that in the presence of partial common duct obstruction, fat-induced increases in bile flow related to increased circulating levels of cholecystokinin are associated with an increase in the diameter of the common duct. Initial analysis of our data indicated that a change in diameter of +/- 1 mm was within the range of measurement error or possibly physiologic variation. In 44 control subjects (24 without a gallbladder), the common duct diameter either remained unchanged, showed an insignificant change of +/- 1 mm, or decreased (greater than or equal to 2 mm). The common duct diameter never showed an increase of more than 1 mm. The results of fatty-meal sonography in 47 patients with suspected partial common duct obstruction were negative in all 28 true-negative cases (specificity, 100%) and were positive (common duct increased by greater than or equal to 2 mm) in 14 of 19 true-positive cases (sensitivity, 74%). Thus, in this study a positive test finding always indicated partial common duct obstruction. Of the true-positive cases, fatty-meal sonography correctly identified seven of eight patients with cryptic obstructive sphincter-of-Oddi dysfunction (stenosis or dyskinesia) and five of nine patients with commun duct stones. We conclude that fatty-meal sonography is a useful noninvasive screening test for evaluating patients with suspected partial common duct obstruction.

Adolescent↗
PubMed1987

Chronic recurrent pancreatitis secondary to a submucosal ampullary tumor in a patient with neurofibromatosis.

We report a 45-year-old nonalcoholic patient with Von Recklinghausen's disease and chronic recurrent pancreatitis. On endoscopy, a benign-appearing submucosal tumor surrounded the papilla of Vater. Cannulation of the pancreatic duct showed a dilated ductal system with subsequent delayed drainage. Endoscopic manometry revealed elevated sphincter of Oddi pressures. Endoscopic sphincterotomy resulted in immediate normal drainage of the pancreatic duct and in subsequent clinical improvement.

Ampulla of Vater↗
PubMed1987

Endoscopic retrograde cholangiopancreatography in children.

Endoscopic retrograde cholangiopancreatography (ERCP) is a universally used diagnostic and therapeutic modality in adults with pancreaticobiliary tract disease; its use in children with similar problems has been limited. We have performed ERCP procedures in 39 children and adolescents (aged 6 months to 18 years; mean 12.5 years), using the standard adult and pediatric side-viewing endoscopes. In selected cases, ERCP manometric study of the sphincter of Oddi, endoscopic sphincterotomy, or balloon extraction of common bile duct stones was performed. Nineteen patients had significant or abnormal structural findings, including pancreas divisum (four patients); sclerosing cholangitis (three); and choledochal cyst, chronic pancreatitis, choledochocele, pancreatic pseudocyst, common bile duct stone, and sphincter of Oddi motor dysfunction (two each). In all instances in which patients required operation, ERCP examination provided specific anatomic detail that was useful for planning appropriate intervention. The only significant complication after ERCP was mild pancreatitis, which occurred in four patients and responded to supportive, short-term measures.

Adolescent↗
PubMed1987

Sonographic evaluation of resting gallbladder volume and postprandial emptying in patients with gallstones.

We investigated fasting gallbladder volume and gallbladder emptying in response to a fatty meal in 20 patients with asymptomatic gallstones and compared the results with findings from healthy controls. Compared with control subjects without gallstones, the majority of patients with gallstones exhibited a higher resting gallbladder volume, less fractional emptying after a fatty meal, and a higher postmeal residual volume. These abnormalities all appeared to stem from an abnormally high resting gallbladder volume. Whether the increased gallbladder volume and decreased postprandial fractional emptying in the gallstone patients represents a primary or secondary abnormality remains to be determined. The results suggest that in some patients decreased gallbladder contractility may contribute to gallstone development or proliferation.

Adult↗
PubMed1986

Radiologic amyl nitrite test for distinguishing pseudoachalasia from idiopathic achalasia.

In a simple radiologic test, amyl nitrite inhalation seems to distinguish patients with pseudoachalasia from those with idiopathic achalasia. In three pseudoachalasia patients with tumor infiltration of the distal esophagus, the narrow lower esophageal sphincter segment was unaffected by the smooth-muscle relaxant effect of amyl nitrite. In contrast, amyl nitrite caused a measurable increase of 2 mm or more in sphincter diameter in nine patients with idiopathic achalasia. The amyl nitrite test may be a useful method for distinguishing patients with pseudoachalasia from those with idiopathic achalasia.

Adult↗