Cineradiographic Examination Research Articles

Esophageal Dysfunction in

The literature is almost totally devoid of data concerning esophageal pathology and dysfunction in diabetes mellitus. Cineradiographic examination of the esophagus in 14 patients with evidence of neuropathy-gastroenteropathy revealed evidence of dysfunction in 12, manifested chiefly by absence or diminution of the primary peristaltic wave, presence of tertiary contractions, and marked delay in esophageal emptying with the patient in the recumbent position. No patient showed difficulty in the initiation of swallowing or any regurgitation of barium sulfate from the esophagus into the pharynx. In marked contrast to the high cineradiographic incidence of dysfunction, symptoms referable to the esophagus were present in only three patients and were severe in only two. This study makes clear that esophageal motor dysfunction is a common finding in diabetic neuropathy-gastroenteropathy and that it results, on occasion, in dysphagia.

The significance of webs in the hypopharynx and upper esophagus.

The true incidence of webs in the hypopharynx and upper esophagus is not known, as many are probably not detected by the routine radiological examination of the upper gastrointestinal tract. This is particularly true if the patient has no symptoms referable to deglutition. Since the introduction of cineradiologic technics in the Columbia-Presbyterian Medical Center five years ago for the routine examination of the upper gastrointestinal tract, the detection of webs has increased sharply. During the ten-year period, 1950–1960, only 9 patients with webs were discovered, while during the past five years, 44 additional examples of this lesion were detected, 15 during the immediate past year. This fact prompted a review of 53 cases with radiographically demonstrable webs in the pharynx or upper esophagus that have been seen during the past fifteen years, in order to assess the clinical significance of the finding (Table I). Clinical Material The ratio of whites and Negroes was 30 to 23 and of males to females 22 to 31. Most of the webs occurred in the cervical esophagus near the cricopharyngeus (Fig. 1), although 4 were in the hypopharynx (Fig. 2) and 3 in the upper thoracic esophagus (Fig. 3). The absence of a definite anatomic landmark for the pharyngoesophageal junction makes precise localization of some webs difficult except when a cricopharyngeal impression is present. Some webs occur at or just below the cricopharyngeus and, because this is properly a part of the pharynx, they could be regarded as pharyngeal (Fig. 4). Multiple webs, present in 3 patients (Figs. 5 and 9), may involve either the esophagus, the hypopharynx, or both. Radiographic Aspects In our opinion, the use of cineradiography is responsible for the increase in number of cases of esophageal webs diagnosed during the past five years. Many are visible for only a fraction of a second when the pharynx or esophagus is maximally distended, and are perhaps demonstrated on only one or two frames at camera speeds of 8 to 10 frames per second. Webs are also overlooked because the hypopharynx and cervical esophagus are not carefully studied, especially when there are no symptoms referable to this area. While we begin the routine cineradiographic examination in the mesopharynx with camera speeds of 8 frames per second, a careful study ideally requires camera speeds of 24 to 30 frames per second because of the extraordinary rapidity of deglutition. The typical web appears radiographically as a filling defect arising at right angles from the anterior wall of the cervical esophagus, usually at or just below the cricopharyngeus. Its thickness is uniform and rarely exceeds 2 mm. Immediately beneath the web, in some cases, it is possible to recognize a short segment of esophagus in which distensibility is limited. The lower limit of this segment may be separated from the normal esophagus by a second web (Fig. 5).

Cineradiographic Examination of the Upper Gastrointestinal Tract in Obstructive Jaundice

An upper-gastrointestinal tract examination is usually performed in patients with obstructive jaundice, although the diagnostic accuracy is thought by many to be quite low. A prospective study was undertaken to determine whether the diagnostic accuracy of the gastrointestinal examination could be improved by the use of cineradiography. Sixty-one patients thought to have obstructive jaundice were studied by cineradiography. The diagnoses obtained were compared with clinical and pathological findings. The diagnosis of periduodenal carcinoma was correctly made or excluded for 50 patients, giving an accuracy level of 82%. These findings indicate that cineradiography provides a convenient means of complete recording of changes in the duodenum which may be analyzed in detail and at length, and which can result in a higher level of accuracy in the diagnosis of periduodenal carcinoma than is obtainable by conventional methods.

STUDIES ON THE 2ND STAGE OF DEGLUTITION BY CINERADIOGRAPHIC METHOD

Cineradiographic method has made possible detailed visual analysis of the 2nd stage of deglutition and its pathologic physiology. In this study were done the cineradiographic examinations at 54 subjects; 10 were considered to be normal, 44 were pathologic.According to measurement of tongue base mortion and pharyngeal peristal wave at every frame of the cineradiograph was formed the cineradiographic pattern of deglutition which consist of upper, middle and lower pharyngeal peristaltic wave pattern (U.P.W.P., M.P.W. and L.P.W.P.) and tongue base mortion pattern (T.B.M.P.).In normal cases, U.P.W.P. was consisted of a large positive wave, M.P.W.P.; a small negative and medium positive wave, L.P.W.P; a large negative wave, T.B.M.P.; the 1st small negative and positive, the 2nd large negative and positive waves. From these elements, author concluded that the positive waves of U.P.W.P. and M.P. W.P., the negative wave of L.P.W.P., and the 1st positive and the 2nd negative wave of T.B.M.P. were considered basic factor at swllowing.In pathologic cases; a dominant pharyngeal peristaltic wave was found in patients who were suffered tongue base resection, the 12th cranial nerve paralysis, cleft palate or upper esophageal stricture. In laryngectomized patients was observed a large pharyngeal peristaltic wave or abnormal pharyngeal constrictive wave. A most dominant tongue base mortion was observed in laryngectomized patients with partial hypopharyngeal constrictor and cervical esophagus resection, and the 9th and 10th cranial nerve paralysis. In the patients who were suffered the 9th, 10th and 12th cranial nerve paralysis, were observed that pharyngeal peristaltic wave and tongue base mortion were weak and showed incomplete deglutition.Based on the above results, author concluded that the distortion in pathologic deglutition was considered to be adaptation by the residual function with its hyperactivity and fenctional modification and deglutition was classified 4 types; normal tongue base mortion, pharyngeal peristaltic and paralytic types.

A Cine-radiographic Examination of Some Polish Phonemes

A Cine-radiographic Examination of Some Polish Phonemes

Swallowing defects after poliomyelitis.

Cineradiographic examinations have been performed upon eight patients complaining of difficulties in swallowing following bulbar poliomyelitis. The films show defective expression of the contents of the pharynx due to impairment of the normal wave of peristalsis, the difficulty being aggravated by obstruction, caused by failure of the muscles controlling the lower end of the lateral food channels and the mouth of the osoephagus to relax. In all cases the middle constrictors of the pharynx were considerably weakened. When swallowing the patients used all the means they retained of reducing the size of the pharyngeal cavity to the smallest possible dimensions. The bearing of these findings upon treatment and prognosis is discussed.

Safe exposures in cineradiography.

Details are given of radiation dosage received during indirect cineradiographic examination without image intensification. The technique described allows films of satisfactory quality to be produced without danger of overdosage.

Closure of the larynx.

Negus (1949) described the larynges of many species of animals and endeavoured to correlate the peculiarities of structure with their particular habits. His studies seemed to indicate that the larynx of all animals is primarily a sphincteric mechanism designed to prevent the entry of water or other harmful substance into the lungs, and to regulate the flow of air in and out of the lungs. The ability to use the larynx for the production of sound appeared to be a secondary development dependent upon the necessity for communication. An account of cineradiographic studies of the mode of closure of the larynx in man during deglutition has been published (Ardran and Kemp, 1952). The present paper is concerned with the alterations in the lumen of the larynx during breathing and phonation. A preliminary communication has already been made (Ardran, Kemp and Manen, 1952). We have used indirect cineradiography on 35 mm film at 25 frames per second (Ardran and Tuckey, 1952) to study the movement of the larynx and the related structures. Several examinations of more than 200 normal European adults of both sexes were made in the antero-posterior and lateral projections. Many still radiographs (Ardran and Kemp, 1953) and tomograms of the larynx were also taken. Cineradiographic examinations were made of three volunteers while a laryngologist was examining the larynx with a mirror. Twenty hospital patients were also examined after iodised oil had been introduced into the trachea for bronchography, the oil from the lungs being used to coat the interior of the larynx.