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Biomedical subjects

H A Munitz

Publications and source records attributed to H A Munitz.

At least 19 recordsLinked to original sources
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↗
PubMed1987

Primary renal lymphoma. Does it exist?

Although secondary renal involvement from systemic lymphoma is common, primary lymphoma of the kidney is not well recognized. One case is reported and 27 cases purported to be primary tumors are reviewed. From these cases three conclusions have been drawn: it is reasonable to assume that renal lymphoma can be a primary lesion; almost all patients with primary renal lymphoma will develop extrarenal lymphomatous disease shortly after diagnosis of their renal tumor; and survival for more than 1 year after diagnosis is rare.

Angiography↗
PubMed1987

Natural progression of the lower esophageal mucosal ring.

Among 390 patients with endoscopically verified lower esophageal mucosal ring (LEMR), 22 cases were identified with previous or subsequent radiologic examinations of the esophagogastric region. Among these, it was found that 2 cases of LEMR had developed from a normal esophagus. In 3 patients, there was increasing stenosis of the LEMR. In 8 cases, the LEMR was transformed into an esophageal stricture. In 10 of the 13 cases, esophagitis of varying degree was present endoscopically. In the 9 patients exhibiting no change in the LEMR, only 1 patient had esophagitis. The data suggest that there is a potential progression from normal esophagus to lower esophageal ring to esophageal stricture that occurs in association with reflux esophagitis.

Adult↗
PubMed1986

Analysis of a multiphasic radiographic examination for detecting reflux esophagitis.

Radiographic and endoscopic findings were correlated in 46 normal patients and in 49 with reflux esophagitis to assess the efficacy of a multiphasic examination employing mucosal relief full-column, and double-contrast techniques. Esophagitis was graded endoscopically as mild, moderate, or severe, and the quality and sensitivity of each technique and of the examination as a whole were determined. The radiographic specificity in the normal patients was 98%. The overall sensitivity was 65% for all grades of esophagitis, and 90% for the moderate and severe grades. Sensitivities of the individual techniques were: mucosal relief: 43%; full-column: 53%; double-contrast: 45%. These differences were not statistically significant. We conclude that a combination of radiographic techniques is needed to detect reflux esophagitis optimally.

Esophageal Stenosis↗
PubMed1986

The abnormal nephrogram.

Recognition of qualitative abnormalities in the nephrogram may be as important as the recognition of structural abnormalities for the detection of renal disease.

Angiography↗
PubMed1986

Single-contrast vs double-contrast barium enema in the detection of colonic polyps.

Radiographic and colonoscopic correlation in 139 patients with 234 colonic polyps compared the sensitivity of single- and double-contrast barium enema. Single-contrast barium enema detected 68 (80%) of polyps, with 72% of polyps under 1 cm and 94% of those 1 cm or over detected. Double-contrast barium enema detected 135 (91%) of 149 polyps, with 88% of polyps under 1 cm and 96% of larger polyps detected. Thus, the double-contrast barium enema was more effective than the single-contrast examination only for detection of polyps under 1 cm. The single-contrast barium enema was more likely performed on patients in poor physical condition and in those over 70 years old. The results suggest that for elderly patients, who may have difficulty in cooperating for a double-contrast enema, a properly performed single-contrast examination is an acceptable option.

Adenoma↗
PubMed1986

Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring.

Radiographic and endoscopic sensitivities were compared in 60 patients with lower esophageal mucosal ring. Barium esophagram detected 57 (95%) rings, all shown by the prone full-column technique. Double-contrast technique in 39 patients demonstrated only 18 (46%) rings. Endoscopy detected 35 (58%) of 60 rings. Endoscopic sensitivity depended on ring caliber with detection of 18 (82%) of 22 rings 13 mm or less in caliber, 14 (54%) of 26 14-19 mm rings, and three (25%) of 12 rings 20 mm or wider. Dysphagia was present in 13 of 25 patients with rings undetected by endoscopy. The caliber of the fiberoptic instruments used also affected endoscopic detection, with 47% of the rings being diagnosed with narrower endoscopes and 76% being diagnosed with larger instruments. Thus, the radiographic examination was more accurate in detecting lower esophageal mucosal ring and should be used initially in patients with dysphagia and suspected lower esophageal narrowing.

Adult↗
PubMed1985

Upper gastrointestinal series: patient management and a study of 199 cases.

Records of 199 patients were analyzed retrospectively after upper gastrointestinal (UGI) series to assess its impact on patient management. Symptoms most predictive of an abnormal UGI series were dysphagia, UGI hemorrhage, abdominal pain, and chest pain. However, 23% of inpatients with seemingly trivial symptoms had shown abnormal results of the study. Overall sensitivity of the UGI series was 65%, which rose to 82% if esophagitis, gastritis, and abnormalities of the postoperative stomach were excluded. Effects on patient management included: serious pathologic change ruled out (53%), further studies ordered (21%), change of therapy (17%), existing therapy continued (16%), surgery performed (7%), and radiologic abnormality ignored (5%). In no case did the combination of initial screening by UGI series followed by endoscopy as indicated lead to subsequently reported morbidity or mortality due to a failure of diagnosis.

Digestive System↗
PubMed1985

Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques.

Three hundred multiphasic examinations of the lower esophagus and esophagogastric region were assessed to determine the individual sensitivities of the full-column, mucosal relief, and double-contrast techniques in the detection of common structural abnormalities, such as hiatal hernia, lower esophageal rings, and peptic strictures. In 159 patients, there were 211 structural abnormalities including 153 hiatal hernias, 35 mucosal rings, 20 peptic strictures, and 3 esophageal diverticula. The overall sensitivity of the full-column technique in detecting these abnormalities was 100% compared to 52% and 34% for the mucosal relief and double-contrast techniques, respectively. We conclude that the prone full-column technique must be incorporated into any examination of the esophagogastric region if these common abnormalities are to be demonstrated reliably.

Adolescent↗
PubMed1985

Predictive relationship of hiatal hernia to reflux esophagitis.

The relationship between hiatal hernia and reflux esophagitis was compared in 93 patients who underwent both radiographic and endoscopic examination of the esophagus. In 46 patients with a normal esophagus shown endoscopically, hiatal hernia was present in 59%, while 94% of 47 patients with reflux esophagitis had hiatal hernia. The positive and negative predictive values for hiatal hernia in diagnosing or excluding esophagitis were 62% and 86%, respectively. Extrapolation of these data and review of the literature suggest that much of the confusion concerning the relationship between hiatal hernia and reflux esophagitis is based on reports of populations with considerable variation in the prevalence of esophagitis and in which the radiographic criteria for diagnosing hiatal hernia have not been uniformly applied.

Esophagitis, Peptic↗
PubMed1985

Colonoscopy and the barium enema: a radiologic viewpoint.

Adherents of colonoscopy are recommending that it replace the radiologic examination as the initial diagnostic study of the colon. We present the radiologic view, supporting the barium enema as a more practical approach to initial diagnostic evaluation. The radiologic examination is an equally reliable, less costly, and much safer method for detecting colonic disease.

Barium Sulfate↗
PubMed1985

Detailed per-oral small bowel examination vs. enteroclysis. Part I: Expenditures and radiation exposure.

Time involved, patient reaction, and radiation exposure were compared for 25 patients undergoing a per-oral small bowel series and 18 having enteroclysis. For the per-oral study, mean room time was 17 minutes and fluoroscopy time was 4 minutes; for enteroclysis, mean room time was 44 minutes and fluoroscopy time was 22 minutes. Side effects were categorized as mild to moderate in two thirds of patients having enteroclysis, whereas they were minimal in 20% of those having the per-oral examination. Radiation exposure was five times greater for enteroclysis. These factors should be considered along with the age of the patient, indications for the examination, and the accuracy of the technique when planning a study of the small bowel.

Barium Sulfate↗
PubMed1985

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy.

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.

Crohn Disease↗
PubMed1985

Duodenitis: endoscopic-radiologic correlation in 272 patients.

Potential radiologic findings of duodenitis were investigated in 272 patients, 157 with endoscopically diagnosed duodenitis and 115 endoscopically normal controls. The study assessed the value of four signs: folds more than 4 mm thick, mucosal nodules, bulbar deformity, and erosions. The most sensitive signs were thickened folds (72.0%) and nodularity (48.4%), while demonstration of erosions was the least sensitive (10.8%). Overall sensitivity (77.7%) approximated that for the radiologic diagnosis of peptic ulcer or esophagitis. Radiologic specificity (76.5%) was in the same range.

Adolescent↗