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J C Lappas

Publications and source records attributed to J C Lappas.

47 records · Page 3Linked to original sources
PubMed1983

Anatomical extent of fiberoptic sigmoidoscopy.

The anatomical extent of fiberoptic sigmoidoscopy was determined by placing a clip on the colonic mucosa and subsequently locating the clip on barium enema. A 60 cm exam viewed the entire sigmoid colon in 81% of patients. Exams of 50-55 cm, 40-45 cm, and 30-35 cm extent viewed the entire sigmoid colon in 68%, 27%, and 13%, respectively. The 50-55 cm and 60 cm exams collectively viewed 90% and 95% of the sigmoid colon surface, respectively. The 30-35 cm and 40-45 cm exams collectively viewed 53% and 70% of the sigmoid colon surface respectively. The anatomical extent of fiberoptic sigmoidoscopy clearly exceeds that of rigid sigmoidoscopy. These data help to define the diagnostic potential of fiberoptic sigmoidoscopy.

Adult↗
PubMedDate not supplied

Nasointestinal tube for decompression or enteroclysis: experience with 150 patients.

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression of distended small bowel. In all patients with a preexisting nasogastric tube, the replacement by the decompression/enteroclysis tube was considered more comfortable by the patients. Successful placement of the tube in the jejunum was achieved in 147 of 150 consecutive patients on the initial attempt. The use of this tube obviates dual intubations for decompression and enteroclysis, the attendant discomfort on the patient, and it expedites subsequent performance of enteroclysis if needed. The complications reported with other long intestinal tubes were not observed with this device.

Adolescent↗
PubMedDate not supplied

Radiology of small bowel obstruction: contemporary approach and controversies.

The radiologic workup of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this complex situation have undergone considerable changes over the past two decades. The diagnosis and treatment of small bowel obstruction, a common clinical condition often associated with signs and symptoms similar to those seen in other acute abdominal disorders, continue to evolve. This article examines the changes related to the use of imaging in the diagnosis and management of patients with this potentially dangerous problem and revisits pertinent controversies.

Barium Sulfate↗
PubMedDate not supplied

Current status of small bowel radiography.

BACKGROUND: In the past, small bowel examinations were usually ordered for the sake of "completeness." As a result, small bowel radiography was performed casually and without attention to detail. This review examines pertinent clinical issues and the recent contribution of small bowel radiography to the evaluation and management of the patient with suspected small bowel disease. Recommendations for the clinical utilization of small bowel radiography are discussed. METHODS: Analysis of pertinent citations addressing valid indications for, and technique of, small bowel radiography from 1980 to July 1995 through a computerized bibliographic search (Medline and Current Contents). RESULTS: Accepted clinical indications for small bowel radiography include (1) unexplained gastrointestinal bleeding, (2) possible small bowel tumor, (3) small bowel obstruction, (4) Crohn disease, and (5) malabsorption. The current literature reflects the limitations of the conventional small bowel follow-through, various modifications to improve its clinical yield, the important contribution of enteroclysis in the workup, and subsequent management of patients with possible small bowel disease. A controversy in the radiology literature exists as to whether to use the small bowel follow-through or enteroclysis as the primary method of examining the small bowel. CONCLUSION: The thoughtful selection of patients by clinicians for small bowel radiography is essential to make radiologic evaluation cost effective. The incidence of disease of the small intestine is low and is associated with nonspecific symptoms. Because of the inherent difficulty of visualizing numerous loops of an actively peristalsing bowel, a reliable imaging method is needed that not only detects small or early structural abnormality but also accurately documents normalcy. The yield of information provided by enteroclysis and its high negative predictive value suggests that it should be the primary method for small bowel examination. The "overhead"-based conventional small bowel follow-through should be abandoned. The "fluoroscopy"-based small bowel follow-through augmented when necessary by the peroral pneumocolon or the gas-enhanced double-contrast follow-through method is an acceptable alternative when enteroclysis is not possible.

Crohn Disease↗
PubMedDate not supplied

Effect of instrument diameter on the depth of penetration of fiberoptic sigmoidoscopes.

Newer fiberoptic sigmoidoscopes tend to have smaller diameter insertion shafts than older models. The extent to which this diameter affects how deeply an instrument can be inserted into the colon and the frequency with which sigmoidoscopes of different diameters could reach more proximal areas of the colon was evaluated. Instrument diameter did not influence the length of the sigmoidoscope shaft that could be introduced into the patient. However, when fully inserted to 60 cm, the 12-mm diameter sigmoidoscopes viewed significantly less of the sigmoid and descending colon than did the 16-mm diameter sigmoidoscopes. This lesser degree of anatomic depth of penetration has direct implications for the diagnostic capabilities of smaller diameter instruments.

Fiber Optic Technology↗
PubMedDate not supplied

Quality of air contrast barium enema performed the same day as incomplete colonoscopy with air insufflation.

The quality of 17 air contrast barium enemas performed the same day as incomplete colonoscopies using air insufflation was compared with 21 air contrast barium enemas performed on a different day from incomplete colonoscopies. A gastrointestinal radiologist blinded to the timing of the procedures reviewed the barium studies scoring them as 1 (unsatisfactory) to 4 (excellent) in four areas. The mean overall quality score for the air contrast barium enemas done the same day as incomplete colonoscopy was 3.29 vs. 2.97 for those done on a different day (p = 0.24). There were no significant differences in quality scores between same-day versus different-day air contrast barium enemas for the specific parameters of quality of distention, barium coating, and amount of spasm. We conclude that when colonoscopy using air insufflation is incomplete because of looping or angulation, air contrast barium enema can be done the same day without impairing the quality of the barium study.

Air↗
PubMedDate not supplied

The value of opacification of the esophagus by low density barium paste in computer tomography of the thorax.

A 3% barium paste was used in the CT evaluation of 100 normal and 60 abnormal esophagi. Successful esophageal opacification occurred in 87% of both groups. In cases of extrinsic disease involving the esophagus the contrast medium administration assisted in separating the esophagus from adjacent mass lesions, as well as identifying displacement, compression, proximal dilatation, and length of involvement. In cases of esophageal carcinoma the contrast medium administration assisted in the measurement of wall thickness and length of the lesion as well as identification of the site of origin of the tumor. The contrast medium was simple to administer, well tolerated, and did not produce scan artifacts.

Adenocarcinoma↗
PubMedDate not supplied

Normal and abnormal temporomandibular joints as demonstrated by magnetic resonance imaging.

Magnetic resonance imaging of the temporomandibular joint (TMJ) was performed on two normal volunteer subjects and two symptomatic subjects using a 0.15 T resistive magnet. A spin echo pulse sequence with a TE of 38 ms and a TR of 500 ms was employed. The TMJ meniscus is a low signal structure, and the bilaminar zone behind it is a relatively high signal structure. In normal closed mouths, the demarcation between meniscus and bilaminar zone is located at the vertex position above the mandibular condyle. When the condyle translates, the posterior portion of the meniscus bulges into the joint space. Dislocated meniscus can be identified by a gray mass anterior to the condylar head. The joint space is filled with the higher signal of the bilaminar zone. In non-reducible dislocations, the meniscus remains anterior to the condylar head with opening of the mouth. Reduced dislocations appear similar to normal joints in the open mouth.

Cartilage, Articular↗
PubMedDate not supplied

Clinical utility of enteroclysis.

The incidence of pathology in the small bowel is substantially lower than in the upper gastrointestinal tract or colon. This is fortunate since the small bowel, with its unique anatomy and remote location is the most difficult section of the gastrointestinal tract to study. Instillation of contrast into the small bowel lumen can be achieved by the oral route or by the more recently refined technique of small bowel intubation/infusion called enteroclysis. This brief review will focus on the clinical infusion indications for and efficacy of enteroclysis and the relative advantages of enteroclysis over oral methods of small bowel radiography.

Crohn Disease↗
PubMedDate not supplied

Defecography: techniques for improved image quality.

Defecography is a radiographic study that demonstrates the physiological process involved when the rectum evacuates. Fluoroscopy, video recording and spot films are used to record the sequence of events that occur during defecation. Proper radiographic techniques and procedures must be used to demonstrate pathological conditions such as rectoceles, rectal intussusception and prolapse of the rectum.

Defecation↗