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Stephen E Rubesin

Publications and source records attributed to Stephen E Rubesin.

34 records · Page 2Linked to original sources
PubMed2003

Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring.

OBJECTIVE: To determine the correlation between massive gastroesophageal reflux (GER) on barium studies and pathologic acid reflux on 24-h pH monitoring. METHODS: A search of hospital records from January 1997 to January 2001 revealed 28 patients who underwent both barium studies and 24-h pH monitoring. The radiologic reports were reviewed to determine the presence and degree of GER. Patients with reflux to or above the thoracic inlet either spontaneously or with provocative maneuvers in the recumbent position were classified as having massive reflux, whereas the remaining patients with reflux below the thoracic inlet or no reflux comprised the control group. The pH monitoring reports were also reviewed to determine if pathologic acid reflux was present in the recumbent position. The findings on these studies were then compared to determine the frequency of pathologic acid reflux in the recumbent position on pH monitoring in patients with massive reflux on barium studies compared with the control group. RESULTS: Massive GER was observed on barium studies in 11 (39%) of the 28 patients and reflux below the thoracic inlet or no reflux in the remaining 17 patients (61%) who comprised the control group. All 11 patients (100%) with massive reflux on barium studies had pathologic acid reflux on pH monitoring in the recumbent position compared with six (35%) of 17 patients in the control group (P = 0.0009). The pH in the distal esophagus on pH monitoring was less than 4.0 for 13.1% of the recumbent period for patients with massive GER on barium studies compared with 6.2% of the recumbent period for the control group (P = 0.0076). CONCLUSION: Although 24-h pH monitoring remains the gold standard for the detection of GER, our experience suggests that patients with massive reflux on barium studies are so likely to have pathologic acid reflux in the recumbent position that these individuals can be further evaluated and treated for their gastroesophageal reflux disease (GERD) without need for pH monitoring.

Barium Sulfate↗
PubMed2003

Epiglottic carcinoma as a cause of laryngeal penetration and aspiration.

OBJECTIVE. The purpose of our investigation was to review a series of patients with epiglottic carcinoma to elucidate the clinical and videofluoroscopic findings in these individuals. CONCLUSION. Patients with epiglottic carcinoma often present with symptoms of aspiration or pharyngeal dysphagia of relatively brief duration in the absence of a preexisting neurologic disease. In this clinical setting, barium studies are useful not only for detecting the epiglottic carcinoma but also for delineating the presence and mechanism of laryngeal penetration or tracheobronchial aspiration.

Adult↗
PubMed2003

Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus.

OBJECTIVE: The purpose of our investigation was to determine the usefulness of barium studies for differentiating benign and malignant strictures of the esophagus. MATERIALS AND METHODS: A search of radiology and endoscopy files revealed 100 patients with esophageal strictures on barium studies who underwent endoscopy (with endoscopic brushings or biopsy specimens in 57). The images from these barium studies were reviewed by two gastrointestinal radiologists who were unaware of the clinical, endoscopic, and pathologic findings; these observers classified the strictures as having a benign, malignant, or equivocal appearance. The radiographic data were correlated with the endoscopic and pathologic findings to determine the usefulness of barium studies for differentiating benign strictures from malignant tumor. RESULTS: Of the 100 esophageal strictures detected on barium studies, 75 (75%) had a benign radiographic appearance, 11 (11%) had a malignant appearance, and 14 (14%) had an equivocal appearance. None of the 75 patients with radiographically benign strictures had malignant tumor on endoscopy, which revealed benign strictures in 48 patients and no definite strictures in the remaining 27. Conversely, all 11 patients (100%) with radiographically malignant strictures had malignant tumor on endoscopy. Finally, 13 (93%) of 14 patients with radiographically equivocal strictures had benign strictures without tumor on endoscopy and one (7%) had esophageal carcinoma. CONCLUSION: Radiographically benign esophageal strictures are not found to be caused by malignant tumor on endoscopy, so these patients can be treated medically before endoscopy or endoscopic dilatation procedures are performed. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.

Adult↗
PubMed2003

Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia.

OBJECTIVE: The purpose of our investigation was to determine the relationship between the degree of swallowing dysfunction observed on barium studies and the likelihood of developing pneumonia in a large series of patients. MATERIALS AND METHODS: The findings on videofluoroscopic swallowing studies in 381 patients were used to classify these patients into one of five groups: those with normal swallowing; those with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration; those with laryngeal penetration; those with tracheobronchial aspiration; and those with silent tracheobronchial aspiration. Clinical data were also reviewed to determine how many patients had developed pneumonia during the 6 months before or after the barium studies. The data were then analyzed to determine whether the risk of developing pneumonia increased significantly with each level of swallowing dysfunction seen on barium studies. RESULTS: No significant difference was found in the frequency of pneumonia in patients with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration compared with patients with normal swallowing on barium studies (p = 0.85). In contrast, patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration were approximately four times (p = 0.008), 10 times (p < 0.0001), and 13 times (p < 0.0001), respectively, more likely to develop pneumonia than those with normal swallowing. CONCLUSION: Our findings indicate that the likelihood of developing pneumonia is directly related to the degree of swallowing dysfunction seen on videofluoroscopic studies. Patients with no laryngeal penetration-regardless of whether they had normal or abnormal swallowing-have the lowest risk of developing pneumonia. Patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration are, in increasing order of magnitude, significantly more likely to develop pneumonia than patients with normal swallowing.

Adult↗
PubMed2003

Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy.

OBJECTIVE: The purpose of this study was to determine the usefulness of a high-density (250% weight/volume) barium compared with a water-soluble contrast agent for the detection of esophageal leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy. MATERIALS AND METHODS: A search of our radiology database from 1998 to 2001 revealed 46 eligible radiographic studies performed using a water-soluble contrast agent alone or a water-soluble contrast agent followed by barium that showed leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy. The images were reviewed to determine the morphology of the leaks (i.e., blind-ending tracks, sealed-off collections, or free extravasation of contrast material). Medical records were also reviewed to determine whether detection of the leaks seen on the radiographic studies affected patient management. RESULTS: Of the 46 leaks seen on radiographic studies, 23 (50%) were detected with a water-soluble contrast agent and 23 (50%) were detected only with high-density barium. Of the 23 leaks visualized with water-soluble contrast media, six (26%) were characterized by blind-ending tracks, 14 (61%) by sealed-off collections, and three (13%) by free extravasation of contrast material into the mediastinum or neck. Of the 23 leaks visualized only with high-density barium, 19 (83%) were characterized by blind-ending tracks and four (17%) by sealed-off collections. Thus, leaks detected only on images obtained with high-density barium were significantly more likely to be characterized by blind-ending tracks than those detected on images obtained with a water-soluble contrast agent (p = 0.0007). Of the 33 patients with clinical follow-up, the findings seen on these imaging studies affected management in 12 (86%) of 14 patients with leaks depicted by water-soluble contrast media and in 10 (53%) of 19 with leaks depicted only by high-density barium. CONCLUSION: Our findings support the use of high-density barium as part of the routine postoperative radiographic examination when no leaks are detected on images obtained with a water-soluble contrast agent.

Adult↗
PubMed2002

Radiologic imaging modalities in the diagnosis and management of colorectal cancer.

Colorectal carcinoma poses a serious public health threat. Detection in its early stages in the best predictor for long-term survival, which is the impetus for population-based screening programs. We believe that full-colon imaging by either DCBE or colonoscopy is necessary for colon cancer screening because flexible sigmoidoscopy, even if perfect, only detects 50% to 60% of colon cancers, a rate far worse than even the worst rate reported for single-contrast barium enema. Screening for colon cancer with flexible sigmoidoscopy is equivalent to performing a "left" mammogram for the detection of breast cancer. The role of CT colonography is still to be determined. When confronted with a symptomatic patient, barium enema is applied in conjunction with CT to detect primary colorectal carcinoma, to differentiate it from other benign and malignant processes involving the colon, and to assess for disease extent before surgery in selected high-risk patient populations. Pelvic MRI may be useful in the preoperative assessment of patients with rectal carcinoma as a means for assisting surgical planning. CT, MRI, and barium enema are used in postoperative follow-up for detecting local recurrence and distant spread. In response to known difficulty in discriminating between normal postoperative changes and tumor recurrence and in determining the nature of certain liver lesions, FDG-PET has been approved for the detection and localization of recurrent colorectal cancer in patients with rising CEA levels and indeterminate findings on standard imaging studies. Given its current promise of offering high sensitivity, specificity, and accuracy, the indications for PET may well expand in the future, but its final role in still to be determined.

Aged↗
PubMed2002

Barium studies.

Explore the source record for details and available documents.

Barium Sulfate↗
PubMed2002

Evaluation of patients with jejunostomy tubes: imaging findings.

PURPOSE: To determine the frequency and nature of abnormalities observed on radiographs after placement of jejunostomy (J) tubes for enteral nutrition. MATERIALS AND METHODS: Radiology database review revealed that 280 studies of the J tube or of the small bowel with water-soluble contrast material and/or barium sulfate were performed in patients during 10 years. Review of the radiologic reports revealed abnormalities related to the placement of tubes in 105 (38%) cases. Images were reviewed to determine abnormalities in these 105 cases. Radiologic, medical, and surgical records were also reviewed to determine the clinical course and any subsequent interventions. RESULTS: One or more complications were detected in 40 (14%) of 280 cases: small-bowel obstruction in 17 (6%) cases, nonobstructive small-bowel narrowing in six (2%), extraluminal tracks or collections in seven (2%), extravasation of contrast material to the skin in 11 (4%), jejunal hematomas in five (2%), and intussusceptions in four (1%). Mechanical problems related to the tube were detected in 52 (19%) cases, including coiling, kinking, or knotting of the tube in 38 (14%), malpositioning in five (2%), retrograde flow in four (1%), occlusion in four (1%), and a hole in one (<1%). Focal thickening of small-bowel folds was detected in 24 (9%) cases. CONCLUSION: Radiographs in 280 patients with J tubes revealed one or more complications that resulted from tube placement (40 [14%] cases), mechanical problems related to location or function of the tube (52 [19%] cases), and development of focally thickened small-bowel folds (24 [9%] cases).

Adult↗
PubMed2002

Diagnostic yield of barium enema examination after incomplete colonoscopy.

PURPOSE: To determine the diagnostic yield of barium enema examination for neoplastic lesions larger than 1 cm in diameter in the nonvisualized portion of the colon after incomplete colonoscopy. MATERIALS AND METHODS: A review of computerized gastroenterology and radiology databases identified 355 patients who underwent incomplete colonoscopy; 158 (44.5%) underwent subsequent barium enema examination (125 double-contrast and 33 single-contrast barium enema examinations). The radiographic reports were reviewed and compared with the endoscopic reports by one author to identify neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy. Six such lesions were found. In all six cases, the images from the barium enema examinations were reviewed together by two authors to determine the size, location, and morphologic features (polypoid, ulcerated, or annular) of the lesions. Medical, endoscopic, and surgical records were subsequently reviewed by one author to determine whether these represented true- or false-positive radiographic findings. RESULTS: Barium enema examination depicted six possible lesions in the nonvisualized colon after incomplete colonoscopy; five were found to be true-positive radiographic findings, and one was found to be a false-positive finding. The five true-positive findings included two annular lesions (both adenocarcinomas) and three polypoid lesions (all tubulovillous adenomas, with high-grade dysplasia in one). Thus, neoplastic lesions larger than 1 cm were found on barium enema images in the nonvisualized colon in five (3.2%) of 158 patients after incomplete colonoscopy. CONCLUSION: Barium enema examination had a diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy.

Adult↗
PubMedDate not supplied

Radiologic diagnosis of benign esophageal strictures: a pattern approach.

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

Barium Sulfate↗
PubMedDate not supplied

Anterior abdominal wall hernias: findings in barium studies.

Findings of anterior abdominal wall hernias at computed tomography and magnetic resonance imaging are well documented; however, little information is available about the depiction and characterization of such hernias in barium studies, primarily in small-bowel follow-through examinations. Such examinations are performed frequently, and radiologists should be familiar with the hernia features that may be observed. Anterior abdominal wall hernias are best recognized in profile on lateral spot images from a small-bowel follow-through study when one or more loops of bowel extend beyond the fascial planes of the anterior abdominal wall, with luminal narrowing at the entry or exit site of the hernia or at both sites. In some patients, the hernia also can be recognized indirectly on a frontal view because of the displacement and, often, extrinsic compression or deformity of herniated bowel loops. In such cases, additional views should be obtained with the patient in the lateral position to confirm the presence of the hernia with direct visualization of the herniated loops in profile. The reducibility of bowel from an anterior abdominal wall hernia also can be assessed with manual palpation of the abdominal wall while the patient is in the lateral position. Manual palpation performed during fluoroscopy helps determine whether the bowel loops can be returned to the proper location or are fixed in the hernia, an important observation because of the higher risk of obstruction or strangulation when the bowel is incarcerated. Fluoroscopy therefore is a useful technique for the detection and characterization of anterior abdominal wall hernias in barium studies.

Barium Sulfate↗