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Biomedical subjects

R E Koehler

Publications and source records attributed to R E Koehler.

At least 73 records · Page 4Linked to original sources
PubMed1981

Gastric bypass: analysis of weight loss and factors determining success.

Sixty-nine carefully selected patients underwent extensive behavioral modification training and a standard loop gastric bypass procedure. Patients were followed up at frequent intervals postoperatively to ensure their compliance with dietary requirements: (1) three small, solid meals a day, (2) slowly eaten meals with 5 minutes between bites, (3) no liquids with meals, and (4) cessation of eating immediately after hunger ceased. Analysis of weight loss data at a mean of 20 months postoperatively revealed that 90% of patients lost more than 50% of their excess weight, but that weight loss was inversely related to weight at operation (P less than 0.02) and to estimated pouch size (by upper gastrointestinal series) late postoperatively (P less than 0.01). Patients who failed to maintain regular follow-up visits postoperatively lost significantly less weight (P less than 0.01) than those who were seen regularly. Although fewer than half of the patients lost weight beyond the twelfth postoperative month, significant weight loss was seen in about one fourth of the patients as late as 2 years postoperatively when office follow-up was frequent and compliance with dietary measures complete. Abdominal pain and emesis occurred only when the patient failed to comply with the postoperative dietary regimen. Similarly, inadequate weight loss (premature plateau) was also associated with failure of patients to eat slowly and to stop eating when hunger ceased.

Behavior Therapy↗
PubMed1980

Cholecystosonography: accuracy, pitfalls and unusual findings.

Gray scale cholecystosonograms in 200 patients were reviewed. The findings in 133 of the patients were proved correct at surgery or autopsy. The overall accuracy for the detection of gallstones was 92 percent, with a false-negative rate of 4 percent. A false-positive diagnosis of cholelithiasis was made in three patients, two of whom proved to have extensive cholesterolosis. Causes of false-negative studies were the presence of a single small calculus, obseity and a large distended gallbladder. Ultrasound was specific but insensitive in the detection of a thickened gallbladder wall. The significance of a nonvisualized gallbladder by ultrasound and the role of ultrasound in the diagnosis of gallbladder disease are discussed.

Adolescent↗
PubMed1980

Limitations of the post-lymphangiogram plain abdominal radiograph as an indicator of recurrent lymphoma: comparison to computed tomography.

A comparison was made between post-lymphangiogram abdominal radiographs and computed tomographic (CT) scans in 18 lymphoma patients. When radiographs were obtained more than one year after the original lymphangiogram, only a small percentage of the patients had adequate contrast medium remaining in the lymph nodes for a definitive diagnosis. In three cases with apparently adequate residual contrast material, the radiograph did not provide accurate information on the presence or extent of recurrent lymphoma. The authors conclude that CT is the preferred method for the initial staging of patients with lymphoma, as well as for follow-up studies after one year.

Adult↗
PubMed1980

Cystic artery hemorrhage: a complication of penetrating duodenal ulcer.

Erosion of the cystic artery by the direct penetration of a duodenal ulcer is a rare complication of peptic ulcer disease. Two patients with this complication are reported, one of whom had undergone cholecystectomy. Emergency angiography demonstrated extravasation from the cystic artery directly into the lumen of the duodenum. The diagnostic and therapeutic implications of the angiographic findings are discussed.

Aged↗
PubMed1980

Single- and double-contrast techniques in esophagitis.

The relative efficacy of double- and single-contrast radiographs of the esophagus in the detection of esophagitis was compared with findings at esophagoscopy in 52 patients. The addition of double-contrast views to the examination increased the number of radiographic abnormalities seen and led to the radiographic detection of esophagitis in four patients in whom the diagnosis would otherwise have been missed. The use of double-contrast views did not lead to significant improvement in the overall accuracy, however, since their use was associated with an increase in the false-positive interpretation rate. Superficial mucosal irregularity, ulcers, and narrowing were the most specific radiographic abnormalities and all were detected more frequently on double-contrast views.

Adult↗
PubMed1980

Significance of retained barium in the appendix.

Barium is occasionally retained in the appendix after radiographic examinations of the gastrointestinal tract, and its significance has been debated for many years. This report details three cases in which barium was present in the appendix at the time of acute appendicitis. Review of these three cases and 13 cases previously reported suggests that retained appendiceal barium may be significant when it exists in either of two patterns. In patients with appropriate symptoms, a barium appendicolith has the same significance as a calcified appendicolith, strongly suggesting a diagnosis of appendicitis. Barium outlining a dilated appendical lumen also suggests appendicitis in the appropriate clinical setting. The significance of retained barium in the appendix in asymptomatic patients remains uncertain.

Appendicitis↗
PubMed1980

Noncirrhotic nodular transformation of the liver with portal hypertension: clinical, angiographic, and pathological correlation.

Noncirrhotic nodular lesions of the liver are difficult to classify since the etiologies ofmost are unknown. Presented here is the case of a 21-yr-old man with portal hypertension and bleeding esophageal varices in which the gross and microscopic pathological findings have the features of two rare hepatic conditions, partial nodular transformation, and nodular regenerative hyperplasia. The angiographic findings in this caes are strikingly similar to that which has been reported in cases of idiopathic portal hypertension.

Adult↗
PubMed1979

Ultrasonic localization of a non-palpable testis tumor.

A young man was found to have a retroperitoneal seminoma and normal testicles by palpation. Initial diagnosis was an extratesticular primary germ cell tumor until ultrasound examination detected a lesion in the left testicle. A left radical orchiectomy was done and a seminoma of the testicle was found. We recommend ultrasound examination of the testicles to demonstrate occult testicular tumors when faced with the possibility of an extratesticular primary germ cell tumor.

Adult↗
PubMed1979

Iosefamate meglumine: an iodinated contrast agent for hepatic computed tomography scanning.

Iosefamate meglumine, a water-soluble, iodinated compound which is chemically and pharmacologically similar to iodipamide, was studied as a contrast agent for hepatic CT scanning in dogs. The difference between the CT attenuation number of liver and blood increased by 16 EMI units after intravenous injection of iosefamate 150 mg l/kg. The agent may prove useful in improving the CT detection of isodense tumors within the liver.

Animals↗
PubMed1979

Focal irregularity of the rectal mucosa.

Mucosal irregularity seen on air-contrast barium enema may be the only radiographic manifestation of a variety of pathologic conditions of the rectum. Seven patients are described to illustrate the fact that when the rectal mucosal irregularity is focal and well demarcated, neoplastic conditions should head the list of diagnostic possibilities. Adenocarcinoma, verrucose carcinoma, adenomatous hyperplasia, villous adenoma, and metastatic carcinoma can all be manifested in this way. The appearance of these lesions on air-contrast barium enema is contrasted with the diffuse mucosal irregularity characteristic of inflammatory and other rectal conditions.

Adenocarcinoma↗
PubMed1978

Complementary use of ultrasound and computed tomography in studies of the pancreas and kidney.

113 cases of pancreatic and renal disease studied by both ultrasound and computed tomography (CT) were analyzed retrospectively. CT provided a diagnosis when pancreatic ultrasound was unsuccessful due to overlying bowel gas or obesity and when renal ultrasound was unsuccessful due to obesity, reverberations from ribs, small lesions, or multiple lesions. Conversely, ultrasound provided a diagnosis when CT was unsuccessful due to lack of fat planes or respiratory motion. CT usualy distinguished carcinoma from pancreatitis when ultrasound showed a focal echogenic mass. CT resolved renal cyst from neoplasm when ultrasound showed a mixed echo pattern mass.

Diagnosis, Differential↗
PubMed1978

Computed tomographic angiography of the body.

Large and medium-sized blood vessels can be identified on extracranial computed tomographic (CT) scans when a combination of infusion and bolus injection of conventional contrast material is administered. The cases illustrated in this report show that CT angiography can sometimes offer clinically useful information not present on CT scans obtained without contrast injection.

Angiography↗
PubMed1978

Prolonged gallbladder opacification after oral cholecystography.

Recent reports state that prolonged gallbladder opacification after an otherwise normal oral cholecystogram is abnormal and reliably indicates acalculous cholecystitis. In 122 patients on a variety of diets, the frequency with which prolonged gallbladder opacification is detectable one and two days after oral cholecystography was studied prospectively. Prolonged opacification was seen in 75% of patients and did not occur more commonly in those patients with documented gallbladder disease. Prolongation of gallbladder opacification after oral cholecystography is common and cannot be used as the sole criterion for the diagnosis of cholecystitis.

Adult↗
PubMed1978

Double channel pylorus.

Radiographic and clinical features in five patients with the double channel pylorus deformity are reviewed and compared with previously reported cases. The double channel pylorus is a form of gastroduodenal fistula with a characteristic radiographic appearance. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb. A peptic ulcer lies in or immediately adjacent to the accessory channel in almost all cases. The double channel pylorus appears to be an acquired form of peptic deformity in the great majority of cases and is probably more common than the number of reported cases would imply.

Aged↗