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Biomedical subjects

R F Thoeni

Publications and source records attributed to R F Thoeni.

At least 55 records · Page 3Linked to original sources
PubMed1983

Severe corrosive gastritis related to Drano: an unusual case.

A case of lye ingestion by a suicidal patient in the form of Drano in capsules is reported. Although lye ingestion usually causes lesions in the oropharynx and severe esophagitis, in our patient it produced severe gastritis with minimal esophageal findings because of the protective capsules which dissolved primarily in the stomach. Endoscopy should be the first method of evaluating patients with ingestion of corrosives, but an upper gastrointestinal (UGI) series can accurately demonstrate mucosal injury and extent of involvement. UGI can be used as an adjunct in patients incompletely examined by endoscopy and can play an important role in the follow-up examination of these patients.

Adult↗
PubMed1983

The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding.

We examined 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum, or hematochezia to determine the value of the double-contrast barium-enema (DC-BE) examination and colonoscopy/proctoscopy in establishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the two examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and seven of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only eight additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures, and anal tears, and seven of these were found in patients who were older than 50 years of age. We conclude that colonoscopy is superior to the DC-BE examination in the detection of bleeding sites but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 years old or older.

Adult↗
PubMed1983

The role of single and double-contrast radiography in the diagnosis of reflux esophagitis.

Sixty-seven patients with endoscopically proved esophagitis and 25 patients who had no esophageal disease were examined by double-contrast esophagography, followed by a single-contrast examination. The radiographs were evaluated separately and as a combined examination technique by three independent radiologists in a blind analysis. The respective sensitivities were 77% for the single-contrast examination, 80% for the double-contrast examination, and 88% for the combined examination method with no significant statistical difference (P = 0.05). The sensitivity increased for all methods with an increased severity of esophagitis. False positives more frequently occurred with double-contrast radiography, leading to similar accuracy rates for all methods (74% to 77%). The double-contrast examination technique showed an advantage over single-contrast radiography only if a granular pattern and erosions were the only radiographically detectible features of esophagitis. The use of the combined examination technique is recommended.

Adult↗
PubMed1983

Detection of gastritis by single- and double-contrast radiography.

Sixty-eight patients with various types of gastritis, 23 patients with normal stomachs, and four patients with other gastric diseases were examined in a prospective study to assess the sensitivity and specificity of single-contrast (SC) and double-contrast (DC) upper gastrointestinal examinations in the evaluation of gastritis. All patients underwent endoscopy with biopsy followed first by DC and then by SC radiography. The respective sensitivities of SC and DC radiography were 58% and 72% for all examinations and 59% and 77% for adequate examinations only. The respective specificities were 59% and 55% based on all examinations. Both methods were slightly more sensitive in the detection of moderate-to-severe disease, with sensitivities of 60% for SC and 74% for DC examinations as compared with sensitivities of 53% for SC and 70% for DC in the detection of mild gastritis. Useful radiographic features included polypoid defects and erosions detected by both methods, abnormal folds and flattened margins detected by the SC technique, and narrowed lumen and crenulated margins detected by the DC technique. In 93% of all cases, the correct diagnosis was based on two or more of these radiographic features. According to this study, the radiographic sensitivity in the detection of gastritis is reliable only in cases of moderate-to-severe disease and only when based on findings of the DC examination. Neither SC nor DC radiography should be used as the primary screening method for patients with suspected gastritis, and the radiographic diagnosis should be restricted to the terms "erosive" or "nonerosive gastritis."

Adult↗
PubMed1982

Detection of rectal and rectosigmoid lesions by double-contrast barium enema examination and sigmoidoscopy. Accuracy of technique and efficacy of standard overhead views.

The double-contrast barium-enema examination (DC-BE) and endoscopy were compared in 100 patients (126 lesions) to determine the accuracy of each method and assess the efficacy of standard overhead views in detecting rectal and rectosigmoid masses. Seven lesions were missed with DB-BE (accurate rate, 95%) and 20 with endoscopy (accuracy rate, 84%). Lateral and angled rectum views were positive in 74% and 94%, respectively; combining these with supine, prone, and left posterior oblique views, 95% of 121 lesions were detected on at least 2 radiographs. Fifteen of 41 lesions (37%) were missed with the rigid sigmoidoscope, but only 5 of 85 (6%) with the flexible sigmoidoscope. The authors conclude that suspected rectal or rectosigmoid tumors can be diagnosed accurately with only 5 projections, rather than the 11 often employed for the entire colon, and that the flexible sigmoidoscope should be used routinely instead of the rigid sigmoidoscope.

Aged↗
PubMed1982

A clinical trial of oral cholecystography using combinations of contrast agents and two consecutive doses.

Fifteen healthy volunteers underwent a randomized trial of oral cholecystography (OCG) using 5 different combinations of contrast agents given as 2 consecutive doses: Telepaque (iopanoic acid) given with food (TF) or without food (T), Bilopaque (sodium tyropanoate) given without food, and a combination of both agents (TF-B). The density of gallbladder opacification was judged visually on a scale of 1+ to 4+ and quantitatively by a densitometric method. Comparison of gallbladder opacification on the first and second days of the study revealed 52 of 75 (70%) combinations (TF-T, TF-TF,T-T, TF-B, B-B) resulted in improved opacification, 17% in equal opacification, and 13% in worse opacification on day 2. The TF-B combination showed the highest number (9) of excellent (grade 4+) results and the lowest number (2) of poor (grade 1+ and 2+) results, gave the best opacification in 8 volunteers, and had the highest average density difference (0.32) between first- and second-day opacifications. The TF-TF combination was the next most effective, and the T-T combination was the least effective. The results indicate that OCG in 2 consecutive doses is superior to single-dose OCG, and that a combination of TF-B or TF-TF will provide the greatest gallbladder opacification. The TF-B combination is recommended because of better patient tolerance.

Administration, Oral↗
PubMed1982

Double-contrast barium-enema examination and endoscopy in the detection of polypoid lesions in the cecum and ascending colon.

Fifty-three patients with 54 polypoid lesions in the ascending colon and cecum underwent colonoscopy and double-contrast barium-enema examination (DC-BE). Colonoscopy could not completely examine the cecum in three patients (failure rate 6%) and DC-BE had four false positive results. Colonoscopy detected 40 lesions (sensitivity 78%) and DC-BE 45 lesions (sensitivity 88%). A carcinoma and a villous adenoma were missed by both methods. The overall accuracy for colonoscopy was 80%, 76% if corrected for unsuccessful procedures; DC-BE showed accuracy rates of 82% and 83%. In combination, the two methods had 97% accuracy. This study shows that DC-BE is slightly better than colonoscopy for evaluating well-prepared patients with suspected polypoid lesions in the right colon, but stresses the complementary nature of the two methods and the need for repeating negative examinations by one modality in the presence of a positive result by the other.

Adenoma↗
PubMed1982

Work in progress. The anal canal: distinction of internal hemorrhoids from small cancers by double-contrast barium enema examination.

Sixty-six patients with normal anal canals, 66 patients with internal hemorrhoids, and 6 patients with small cancers in the anal canal were examined by double-contrast barium enema examination. Internal hemorrhoids appeared as single nodules in 3 patients, multiple nodules in 59 patients, a polypoid mass in 3 patients, and a varicoid mass in 1 patient. Small cancers appeared as slightly irregular polypoid masses in 5 patients and as a plaque-like lesion in 1 patient. The sensitivity for detecting internal hemorrhoids was 83%, the specificity was 88%, and the overall accuracy was 86%. The sensitivity for detecting small cancers in the anal canal was 83% and the specificity was 98%. Internal hemorrhoids and small cancers in the anal canal can be easily detected and distinguished from one another by double-contrast barium enema examination.

Adult↗
PubMed1982

Postinflammatory polyposis (PIP) of the colon: the radiologic-pathologic spectrum.

The radiologic-pathologic spectrum of postinflammatory polyposis (PIP) of the colon and the evolution of the radiographic appearance of PIP over time were retrospectively studied in 27 patients (21 with ulcerative colitis, 6 with Crohn disease). Two general patterns of radiographic evolution were recognized: progression from active, ulcerating disease to mucosal healing with formation of PIP, and interruption of healing with PIP by recrudescence of active ulceration with inflammatory pseudopolyposis. In these latter cases, disease activity recurred in the same areas in which healing with PIP had been recognized. A review of all pathologic material indicated that the histopathology of PIP is varied and depends, to a large extent, on polyp size.

Adult↗
PubMed1981

Obstructive jaundice as a long-term complication in a patient with liver transplantation.

Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.

Adult↗
PubMed1981

Value of computed tomography in the detection and staging of recurrent rectal carcinomas.

We studied a series of 39 patients who underwent computed tomography (CT) of the pelvis and abdomen following surgery for adenocarcinoma of the rectum. Based on the CT findings, recurrent rectal carcinoma was classified into one of four stages: Stage I, intraluminal mass without colon wall thickening; Stage II, colon wall thickening (greater than 1 cm) without invasion of adjacent structures; Stage IIIA, thickening of the colon wall with direct invasion of adjacent organs but not the pelvic sidewalls; Stage IIIB, extension of mass to pelvic sidewalls; and Stage IV, distant metastatic disease. All 30 patients with recurrent rectal carcinoma had positive CT scans. Overall accuracy was 95% with 0% false negative and 5% false positive interpretations. Results indicate that CT is an accurate method of detecting and staging recurrent rectal carcinoma and for aiding the selection of appropriate therapy.

Adenocarcinoma↗
PubMed1981

Detection and staging of primary rectal and rectosigmoid cancer by computed tomography.

Thirty-nine patients were examined by computed tomography (CT) prior to resection of primary rectal [23] or rectosigmoid carcinoma [16]. There were 3 patients in Stage II [thickened bowel (greater than 0.5 cm) alone], 12 in Stage IIIa (thickened bowel wall and invasion of adjacent tissue, muscles, or organs, but no extension to the pelvic side walls), 18 in Stage IIIb (extension to the pelvic side walls), 6 in Stage IV (pelvic tumor and distant metastases), and none in Stage I (intraluminal mass without wall thickening). CT detected all 39 rectal or rectosigmoid tumors (sensitivity = 100%) and had an overall staging accuracy of 92%. These results show that CT is useful and accurate in detecting and staging primary rectal and rectosigmoid tumors.

Adult↗
PubMed1981

Esophageal carcinoma: pretherapy staging by computed tomography.

Fifty-two patients with proven esophageal malignancy underwent esophagography, computed tomography (CT). esophagoscopy, and/or surgical exploration and resection. On the basis of CT findings, esophageal carcinoma was classified into four stages: stage I, intraluminal mass without esophageal wall thickening; stage II, esophageal wall thickening (greater than 5 mm); stage III, esophageal wall thickening and contiguous spread of tumor into adjacent mediastinal structures such as the trachea, bronchi, aorta, or atrium; and stage IV, any stage with evidence of distant metastatic disease. The stage of esophageal malignancy as determined by CT was correlated with symptoms, location of tumor, esophagography, and surgical findings. Results indicated that CT staging of esophageal carcinoma correlated closely with surgical findings and that local extension, regional adenopathy, and size of tumor mass were better evaluated by computed tomography than by other methods. CT is an accurate method of preoperatively staging esophageal carcinoma, capable of providing staging information heretofore only available by surgical exploration.

Aged↗
PubMed1980

Ectopic pancreas: usual and unusual features.

Nine patients with ectopic pancreas in the stomach (8 patients) and duodenum (1 patient) were studied both radiographically and endoscopically. Correct diagnosis was made by radiography in six cases and by endoscopy in seven cases. Masses radiographically larger than 3 cm in diameter were seen in three patients. The incorrect radiographic diagnoses were related to the presence of a large mass in one patient and to the complications of severe bleeding and gastric outlet obstruction in the other two. Endoscopy and radiography are complementary modalities in the diagnosis of ectopic pancreas.

Adult↗
PubMed1980

The radiographic appearance of erosive duodenitis: a radiographic-endoscopic correlative study.

We studied 12 patients who had had endoscopically proved erosive duodenitis and a radiographic examination of the upper gastrointestinal (UGI) tract, which had been performed within 2 weeks of endoscopy. Radiographic criteria for erosive duodenitis were established by two radiologists and consisted of spasm, thickening of duodenal folds, erosions, and ulcers. Using these criteria, two other radiologists interpreted the radiographs of the 12 patients with duodenitis 15 others with normal duodenums, and five with pancreatic disease. They made correct diagnoses for eight of the patients with erosive duodenitis, nine with normal duodenums, and three with pancreatic disease. A third radiologist interpreted only the 12 misdiagnosed radiographs; he was correct only for three cases of duodenitis. Analysis of these results show that radiographic diagnosis of erosive duodenitis can be made only in advanced disease.

Adult↗
PubMed1980

A critical look at the accuracy of endoscopy and double-contrast radiography of the upper gastrointestinal (UGI) tract in patients with substantial UGI hemorrhage.

Double-contrast radiography and endoscopy were compared in a prospective study of 100 patients with substantial hemorrhage of the upper gastrointestinal (UGI) tract. Endoscopy enabled detection of the primary bleeding site in 93% of the patients and correct diagnosis of 91% of all UGI lesions present. Double-contrast radiography detected 80% of primary bleeding sites and 76% of all UGI lesions present; whether the double-contrast examination was performed before or after endoscopy did not change its ability to detect lesions. Radiography demonstrated 68% (esophagitis) to 86% (duodenitis) of all superficial lesions. Endoscopy missed lesions in the duodenum and esophagus most frequently, while double-contrast radiography missed lesions in the esophagus most frequently. With the two modalities combined, the overall diagnostic accuracy for all lestions was 99%. Endoscopy and double-contrast radiography are complementary techniques for detecting acute bleeding sites of the UGI tract.

Adult↗