A cineradiographic study of deglutitive tongue movement in patients with anterior open bite.
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The purpose of this study was to use cineradiographic images to investigate tongue movement during deglutition in anterior open bite patients with tongue thrust. Each subject had semi-spherical lead markers attached to the tip and dorsal surface of the tongue and was asked to swallow 5 ml of diluted liquid barium. Tongue movement during deglutition was recorded in the mid-sagittal plane with an X-ray VTR system. The deglutition process was divided into 6 stages to analyze the movements of the tip and dorsal surface of the tongue in each stage. In open bite patients, both the tip and dorsum of the tongue were positioned anteriorly and inferiorly at rest and during the buildup of negative intraoral pressure. The dorsum of the tongue tended to move and be positioned anteriorly as the tongue tip protruded and pushed the maxillary and mandibular anterior teeth. The tongue tip traveled a significantly smaller distance from the stage of tongue rest position to that of most retruded tongue tip position and a significantly larger distance from the stage of most retruded tongue tip position to that of tongue tip fixation in open bite patients than in controls. (+info)
Preliminary studies of the gastrointestinal tract with colloidal barium.
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A stable colloidal suspension of barium sulfate has been developed and tested in roentgen examination of the gastrointestinal tract. The new material is rather distinctive in radiographic appearance and can usually be differentiated from simple barium-water mixtures by inspection of roentgenograms of the opacified stomach and small intestine. It usually affords a satisfactory demonstration of the mucosal folds of the stomach and duodenal bulb and is considerably more resistant to flocculation and precipitation by retained gastric secretions. In the small intestine, it has little tendency to undergo flocculation and fragmentation, and permits visualization of fine mucosal configurations with unusual clarity. Its motility is about the same as that of conventional suspensions. Air contrast colon examinations with the colloidal preparation exhibit a very uniform, opaque, and stable coating of the bowel wall and are more consistently satisfactory than when simple barium-water mixtures are used. (+info)
99mTc-stannous colloid white cell scintigraphy in childhood inflammatory bowel disease.
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99mTc-Labeled white cell scintigraphy (WCS) has been used for the investigation of inflammatory bowel disease (IBD) in adults, but data on children are limited. The most common agent used is (99m) Tc-hexamethylpropyleneamine oxime (HMPAO); however, this agent has limitations. In a retrospective study, we assessed the use of (99m)Tc-stannous colloid WCS for the initial evaluation of children with suspected IBD. METHODS: Diagnostic, endoscopic, and contrast radiography results were retrospectively collected from the medical records. Two experienced nuclear physicians unaware of the patient data interpreted the WCS results, with agreement reached by consensus. Statistical analysis was performed on the ability of WCS to detect active disease and localize it topographically and on a comparison of diagnostic methods, using a combination of clinical features and endoscopy as the reference standard. RESULTS: Between 1996 and 1999, 64 patients (35 male and 29 female; mean age, 12.5 y; age range, 2-19 y) had WCS performed, with IBD subsequently diagnosed in 34 patients. (99m)Tc-Stannous colloid WCS had an 88% sensitivity, 90% specificity, and 8.8 likelihood ratio for initial investigation of IBD. Agreement was poor for topographic localization of disease. Small-bowel series had a 75% sensitivity, 50% specificity, and 1.5 likelihood ratio for detecting endoscopic disease of the terminal ileum and proximal colon. CONCLUSION: Our results confirm that WCS is a useful imaging technique for the initial evaluation of patients with suspected IBD. (99m)Tc-Stannous colloid had results at least comparable to those of other WCS agents, and in children, (99m)Tc-stannous colloid WCS should be preferred in view of lower cost, shorter preparation time, and the smaller blood volumes required. (+info)
Oxygen isotope constraints on the sulfur cycle over the past 10 million years.
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Oxygen isotopes in marine sulfate (delta18O(SO4)) measured in marine barite show variability over the past 10 million years, including a 5 per mil decrease during the Plio-Pleistocene, with near-constant values during the Miocene that are slightly enriched over the modern ocean. A numerical model suggests that sea level fluctuations during Plio-Pleistocene glacial cycles affected the sulfur cycle by reducing the area of continental shelves and increasing the oxidative weathering of pyrite. The data also require that sulfate concentrations were 10 to 20% lower in the late Miocene than today. (+info)
Adhesive small bowel obstruction: predictive value of oral contrast administration on the need for surgery.
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INTRODUCTION: adhesive small bowel obstruction (SBO) is a common cause of hospital admission. Nonoperative management is initially recommended unless there is suspicion of strangulation, but its optimal duration is controversial. The aims of our study was to evaluate the usefulness of radiographic small bowel examination with contrast medium to predict the need for surgery in SBO. MATERIAL AND METHODS: this prospective study carried out from January 1999 to December 2001, included 100 patients with clinical and radiological criteria of adhesive SBO. We described the past medical history, as well as clinical picture, blood tests and radiological findings in these patients. Fifty cubic centimeters of 5% barium suspension were given orally, and plain abdominal radiographs were taken at 4, 8, 16, and 24 hours afterwards. A liquid diet was given as soon as the contrast medium appeared in the right colon. Otherwise, surgical intervention was considered based on the outcome of the patient and the criteria of the emergency surgical team. RESULTS: in 70 patients, barium contrast appeared in the right colon, and a liquid diet was tolerated by 69 of them (98.6%). Mean hospitalization time for this group was 43 +/- 17 hours. In the remaining 30 patients, no evidence of barium contrast in the right colon was seen, and 25 of them underwent surgery (75%), while the other 5 tolerated a liquid diet. Mean hospitalization time for this second group of patients was 13.8 +/- 11 days. Sensitivity, specificity, positive predictive value, and negative predictive value for the absence of contrast medium in the right colon within 24 hours as a predictor of surgery were 93, 96, 98 and 83%, respectively. There was a statistical significant relationship (p < 0.01) between the "Presence of contrast medium in the right colon" and "Oral diet tolerance". Only the variable "Number of previous surgical interventions" tended to reach statistical significance (p = 0.07). Tolerance of liquid diet was more likely when patients had more than one previous abdominal surgery. CONCLUSIONS: early oral administration of a radiological contrast medium in patients with adhesive SBO can effectively predict the need for a surgical procedure. It can shorten not only hospital stay, but also the potential morbidity of late surgery, secondary to a prolonged and unsuccessful nonoperative treatment. (+info)
Regional variations in management of rectal cancer in France.
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BACKGROUND: Population-based registries provide excellent data for drawing an accurate picture of disease management practices. The purpose of this study was to determine whether diagnostic and therapeutic management practices for rectal cancer vary in different geographic regions of France. METHODS: Data Issued from nine cancer registries covering 11% of the French population. The files of 683 patients with a rectal cancer diagnosed in 1995 were selected for analysis. RESULTS: Colonoscopy was performed in a mean of 91.6% of patients (range: 80.9%-98.2%) (P=0.01). The practice of colonoscopy concomitantly with barium enema varied greatly, ranging from 1.9%-57.7% of patients (P<0.001). Pretherapeutic work-up practices were significantly different depending on the region with respect to: abdominal CT scans (13.4%-69.2%), thoracic CT scans (0.9%-13.2%) and tumor markers (46.8%-80.8%). There were no significant differences between geographic regions concerning rate of resection, use of colostomy, or tumor stage at diagnosis. Administration of adjuvant radiotherapy (mean, 46.8%; range: 21.6%-70%; P<0.001) and adjuvant chemotherapy (mean, 24.1%; range: 10.3%-40.6%; P<0.05) varied significantly between regions. CONCLUSION: Diagnostic practices and administration of adjuvant treatments vary significantly between geographic regions in France. The recommendations of the French consensus guidelines are only partially adhered to. Practitioners and healthcare Authorities should be aware of these differences in order to provide more harmonious patient care. (+info)
A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening.
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BACKGROUND: Although colorectal cancer screening by using a fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, or barium enema x-ray reduces the incidence of and death from colorectal cancer, the rate of colorectal cancer screening in the general population is low. We conducted a randomized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County, Minnesota, a community in which colorectal cancer screening was promoted. METHODS: At baseline, we mailed a questionnaire about colorectal cancer screening to a random sample of Wright County residents aged 50 years or older who were randomly selected from the Minnesota State Driver's License and Identification Card database (estimated N = 1451). The sample was randomly allocated into three equal subgroups: one group (control) received only the questionnaire, one group received FOBT kits by direct mail with reminders, and one group received FOBT kits by direct mail without reminders. Study participants were sent a follow-up questionnaire 1 year after baseline. We used the responses to the questionnaires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups, along with the associated bootstrap 95% confidence intervals (CIs). RESULTS: At baseline, the estimated response rate was 86.5%, self-reported adherence to FOBT guidelines was 21.5%, and overall adherence to any colorectal cancer screening test guidelines was 55.8%. The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5% (95% CI = -2.9% to 5.9%) for the control group, 16.9% (95% CI = 11.5% to 22.3%) for the direct-mail-FOBT-with-no-reminders group, and 23.2% (95% CI = 17.2% to 29.3%) for the direct-mail-FOBT-with-reminders group. The 1-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8% (95% CI = 3.2% to 12.0%) for the control group, 13.2% (95% CI = 8.4% to 18.2%) for the direct-mail-FOBT-with-no-reminders group, and 14.1% (95% CI = 9.1% to 19.1%) for the direct-mail-FOBT-with-reminders group. CONCLUSION: Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign. (+info)
Barium peritonitis--following barium enema of the proximal colon through a colostomy.
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Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature. (+info)