ABSTRACT
Seventy-seven patients with a primary complaint of persistent cough, wheezing, and/or recurrent pneumonia were evaluated for the presence of occult gastroesophageal reflux disease. Fifty-four patients (70%) had increased esophageal acid exposure on 24-hour pH monitoring of the distal esophagus. In 28% of these patients the respiratory symptoms were thought to be due to aspiration because they occurred during or within 3 minutes after a reflux episode. In the other patients, the respiratory symptoms were either induced by or were unrelated to reflux episodes. The number of respiratory symptoms reported by the patients with increased esophageal acid exposure was directly related to the presence of a nonspecific esophageal motility abnormality (p less than 0.05). This suggested that a motility disorder contributes to aspiration by promoting the aboral flow of refluxed gastric juice. Seventeen patients with increased esophageal acid exposure had an antireflux operation to relieve their respiratory complaints. Patients whose respiratory symptoms induced reflux episodes were not helped by the procedure. Of the other patients, symptoms were abolished by the procedure only in those with normal esophageal motility. It is concluded that the majority of patients suffering from chronic unexplained respiratory symptoms have occult gastroesophageal reflux disease, but only a minority of them are helped by surgery. Carefully performed esophageal function studies are needed to select those patients who will benefit from a surgical antireflux procedure.
Subject(s)
Cough/etiology , Gastroesophageal Reflux/complications , Pneumonia, Aspiration/etiology , Respiratory Sounds/etiology , Adult , Esophagus/physiopathology , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/surgery , Humans , Male , Manometry , Monitoring, Physiologic , Peristalsis , Prospective Studies , RecurrenceABSTRACT
Fifteen patients with a paraesophageal hernia were studied with 24 hour esophageal pH monitoring and esophageal manometry to clarify the physiologic aspects of the cardia and resolve controversies over the type of surgical repair. The results were compared with those obtained in 34 randomly selected patients with a sliding hernia and 18 normal control subjects. Sixty percent of the patients with a paraesophageal hernia had an incompetent cardia on 24 hour pH studies which was associated with a lower esophageal sphincter of normal pressure, short overall length, and a small segment exposed to abdominal pressure. In comparison, 70 percent of patients with a sliding hernia had an incompetent cardia which was associated with a lower esophageal sphincter of low pressure, normal overall length, and a short segment exposed to abdominal pressure. With either type of hernia, symptoms were not helpful in determining the competency of the cardia. When urgent surgery is necessary, repair should include an antireflux procedure. If facilities and time permit, more specific evaluation of the cardia can be performed, and if competent, the repair should be limited to reduction of the stomach and closure of the defect.
Subject(s)
Esophagogastric Junction/physiopathology , Hernia, Diaphragmatic/physiopathology , Hernia, Hiatal/physiopathology , Adult , Aged , Female , Follow-Up Studies , Gastric Acid/metabolism , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/physiopathology , Hernia, Hiatal/complications , Hernia, Hiatal/surgery , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , PressureABSTRACT
We feel that the guidelines described here reflect the state of the art at the time of writing (April 1982). The role of CT scanning is likely to evolve further and nuclear magnetic resonance (NMR) will probably play a significant role in the future. Experience, expertise, and equipment will vary from one hospital to another and thus rigid rules cannot reasonably be applied for the workup of suspected lung cancer. Ideally the diagnostic approach to an individual patient will be highly tailored, not only in regard to the nature of the pulmonary lesion, but also to his or her overall medical and social situation. We have found that a policy of early consultation between clinician and imaging specialist most readily facilitates effective use of available diagnostic resources.
Subject(s)
Lung Neoplasms/diagnosis , Adult , Biopsy , Biopsy, Needle/adverse effects , Bronchoscopy/adverse effects , Cytodiagnosis , False Negative Reactions , False Positive Reactions , Humans , Lung Neoplasms/diagnostic imaging , Mediastinoscopy , Thoracoscopy , Tomography , Tomography, X-Ray ComputedABSTRACT
Three patients with Behçet's syndrome and colitis are described. The radiologic and histologic appearances of the colitis are discussed. The similarities of Behçet's colitis to Crohn's disease are outlined. The cases demonstrate the necessity to consider Behçet's syndrome in the differential diagnosis of inflammatory bowel disease.
Subject(s)
Behcet Syndrome/diagnostic imaging , Colitis/diagnostic imaging , Adult , Behcet Syndrome/diagnosis , Behcet Syndrome/therapy , Colitis/diagnosis , Colitis/therapy , Colon/pathology , Crohn Disease/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , RadiographySubject(s)
Bone Neoplasms/secondary , Brain Neoplasms , Medulloblastoma , Bone Neoplasms/diagnostic imaging , Child, Preschool , Humans , Male , RadiographyABSTRACT
At the present time patients with medulloblastoma survive longer due to improved therapy. The extracranial metastases are a manifestation of the longer survival and may be related to surgical intervention. It is important that clinicians be aware of this entity and not subject a child with a known medulloblastoma to further unnecessary investigation should he/she present with destructive metaphyseal lesions.
