The chewable barium tablet slow tracking of oral and pharyngeal swallowing dysfunction.

Dysphagia can be due to oral or pharyngeal dysfunction as well as to esophageal causes. Oral and pharyngeal disturbances, however, are more common in older people because of their attendant risks of laryngeal, tracheal, and pulmonary aspiration. To guide any dietary prescriptions it is important to establish whether the patient can best tolerate liquids, soft foods, solid chewable boluses, all, or none of these. It therefore becomes important to supplement liquid barium swallowing studies with soft and chewable boluses mixed with barium. Here I describe the novel introduction of chewable barium tablets in conjunction with routine swallowing studies. Chewable barium tablets, if used properly, are safe, supply needed information, and can shorten the evaluation of oral and pharyngeal dysfunction studies. Because of the granular appearance of the tablets, aspiration due to this solid chewable bolus can be distinguished from liquid aspiration. Moreover, if the barium tablets are swallowed whole, they can help delineate esophageal strictures if the oral and pharyngeal phases of swallowing are normal.

Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success.

Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.

Can the radiologist recognize Helicobacter pylori gastritis?

To evaluate radiologic findings of Helicobacter pylori (H. pylori) in the upper gastrointestinal (UGI) tract, we retrospectively reviewed consecutive records of 676 symptomatic adults with gastric biopsies (224 positive) and 150 symptomatic adults with rapid urease tests (57 positive). All the UGI series of patients with positive biopsies or urease tests for H. pylori were compared with the UGI series of patients with negative urease tests. UGI examinations were evaluated blindly by two gastrointestinal radiologists without knowledge of clinical findings, original radiologic interpretations, or test results. They agreed that 8 of 18 (44%) UGIs of patients with H. pylori had abnormally increased gastric folds in the fundus, body, or antrum as compared with none of 14 (0%) UGIs of patients without H. pylori (p < 0.01) (P.P.V. = 1.0). Interobserver agreement was good (kappa = 0.63). Endoscopy in the eight patients with radiographic evidence of enlarged gastric folds all demonstrated marked abnormalities such as prominent gastric folds, gastric erythema, erosions, or peptic ulcers. Our findings indicate that enlarged gastric folds on the UGI series of a symptomatic adult are very suggestive of H. pylori gastritis.

Assessment of pain in patients with juvenile rheumatoid arthritis: relation between pain intensity and degree of joint inflammation.

The relation between pain and joint inflammation in patients with juvenile rheumatoid arthritis has not previously been systematically evaluated. Eighteen patients with juvenile rheumatoid arthritis completed paediatric pain questionnaires and the joints affected were examined by thermography. Although significant correlations were shown between parent and doctor pain intensity ratings and joint temperature, correlations of patient pain intensity ratings and joint temperature were only significant in younger children. The degree of joint inflammation is only one factor of several contributing to the amount of subjective pain experienced by children with juvenile rheumatoid arthritis, indicating the need for a comprehensive assessment of the relatively independent variables of inflammation and pain in children with juvenile rheumatoid arthritis.

Diagnosis and management of complications of percutaneous nephrolithotomy.

The therapeutic management of the complications of percutaneous nephrolithotomy (PNL) depends on the early recognition of these complications. A review of 720 cases revealed the incidence of significant complications to be less than 4%. An algorithm was developed as a guideline for the diagnosis and management of complications of PNL. Early complications included transient bleeding (83 cases), extravasation of urine (52 cases), significant infection (11 cases [2 with septicemia and shock]), and migration of stone fragments into the retroperitoneum (7 cases). Nonrenal complications were present in less than 6% of these patients. These included pleural effusions or pneumothorax (24 cases) and lung atelectasis (19 cases). Late complications were seen in less than 2% of the patients. These included stricture of the ureter with obstruction (5 cases), A-V fistula with or without pseudoaneurysm (7 cases), and subcapsular hematoma (1 case). Therapeutic management included improvement of technique to the use of antibiotics to treat infection. The use of proper drainage and the placement of stent or catheter in the treatment and prevention of further complications has become an integral part of the algorithm for the treatment of complications of PNL. This algorithm recommends the proper diagnostic modality for the detection and evaluation of the extent of the complication. Once detected, the complications of PNL can be minimized with limited permanent changes.

Thermography in posttraumatic pain.

Posttraumatic pain is often associated with complex disturbances of the sympathetic nervous system which also controls microcirculation of the skin. Circulatory skin changes are in turn reflected by altered superficial thermal emission, which can be reliably imaged by thermography. Examples of classic thermographic patterns associated with commonly occurring injuries and detected along cutaneous distributions of peripheral nerves or spinal root dermatomes are presented. Thermographic abnormalities may also occur in ondermatomal distributions to involve an entire hand, foot, or extremity as observed in reflex sympathetic dystrophy. Such thermographic findings often appear before skin or roentgenographic changes become manifest and lead to earlier diagnosis. Prompt and more effective treatment, particularly in reflex sympathetic dystrophy, may thereby be initiated so that full blown, difficult to manage, chronic disability may be averted. The diagnosis of malingering may also be strengthened or suspected if thermographic studies together with other examinations are normal.

Management of male infertility: roles of contact thermography, spermatic venography, and embolization.

The leading cause of male infertility is the presence of varicocele. Recently, selective spermatic vein embolization during spermatic venography has afforded a simple, nonoperative treatment. In this study, liquid crystal contact thermography was employed before spermatic venography and after embolization or surgery. Pretreatment thermographic results were in agreement with venography in 15 of 17 cases as 13 were considered positive and two negative by both methods. Thermography further served to document objectively the immediate physiologic effectiveness of either therapy in controlling spermatic vein reflux into the pampiniform plexus. It therefore provides a noninvasive means of evaluating treatment success or recurrence at an early stage. Preliminary thermographic evidence indicates that embolization is a highly effective treatment of reflux. Thermography can also function as a useful, noninvasive screening technique to aid in selecting patients for spermatic venography and embolization therapy.

Percutaneous extraction of renal stones: experience in 100 patients.

Recent developments in technology and instrumentation have made it possible to remove most kidney stones and many ureteral stones percutaneously. The first 100 cases at this institution were reviewed in which grasping, ultrasonic lithotripsy, basketing, and irrigation were used. In all cases, the follow-up was at least 1 year. The success rates were 92.4% for renal pelvic stones, 92% for caliceal stones, and 68% for ureteral stones. Ten of the 14 patients who required open operation after an unsuccessful percutaneous procedure were among the first 18 patients, whereas only one open operation was needed in the last 40 patients. Proper patient selection; the size, number, and location of stones; proper selection of the nephrostomy site; and the expertise of the operator are critical factors in determining the success rate. To date, the short-term results of percutaneous stone removal have been as good as those of open surgery.

Sonographic findings in leukemic renal disease.

The ultrasonic findings in 10 patients with diffuse leukemic infiltration of the kidneys are described. The findings are analogous to those seen pathologically and include enlargement of the kidneys, diffuse leukemic infiltration of the renal cortex with sparing of the adjacent medullae, loss of definition and distortion of the renal sinus echo complex and a focal mass. The ultrasound findings correlated well with those seen with intravenous urography making it the preferable screening modality for the initial detection of renal involvement, subsequent follow-up and response to therapy in leukemic patients.