Biomedical subjects
Publications and source records attributed to D W Gelfand.
The radiographic demonstration of the small intestinal villi is reported. The villi were demonstrable with both single- and double-contrast methods on routine clinical studies. The primary requirement for their delineation appears to be employment of a high-resolution radiographic system.
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The efficacy of radiology in evaluating dysphagia was studied in 86 patients by comparison to endoscopic findings. In the 66 patients with endoscopic abnormalities radiology was correct in 54, for a sensitivity of 82%. Sensitivity of radiology improved to 95% if mild esophagitis was excluded. In the 20 patients with normal endoscopy, radiology was normal in 18 (90%). Thus radiology proved to be a reliable means of evaluating the esophagus in patients with dysphagia.
A case of thermal burn and stricture of the colon following colostomy irrigation with hot water is described. The initial radiographic features on barium enema simulated nonspecific segmental colitis. Colonic stricture and enterolith formation developed subsequently. This case emphasizes that care should be taken in preparing irrigating and barium enema solutions.
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Gastric ulcer scars, which imply previous peptic ulcer disease, are visible with moderate frequency during double-contrast examinations. This article investigates the radiographic appearance of gastric ulcer scars and the frequency of their occurrence in two differing patient populations. Results with 35 gastric ulcers that were followed to healing indicate that most ulcer scars appear as folds converging toward the ulcer site, at times accompanied by a central depression and/or gross deformity of the stomach. Two series of 200 patients each who underwent double-contrast examinations suggest a 1 to 4% incidence of ulcer scars, dependent upon the population examined.
The effects of cold barium solutions on esophageal motility were studied in 70 patients. Baseline esophageal peristalsis was assessed using barium at room temperature. Twenty-eight patients were then re-examined when chilled barium (4 degrees C) was used and results showed a 45% reduction of primary peristalsis. Forty-two patients were re-assessed when iced barium (3 degrees C) was used and results showed a 58% reduction.
Pneumomediastinum as an iatrogenic complication of a diagnostic procedure is rare [1-7]. We report a case of pneumomediastinum following a double-contrast barium enema examination. With the increasing use of double-contrast barium studies, pneumomediastinum may be an important sign of rupture of the colon during this examination.
A literature review of Western publications for the reported sensitivities of single- and double-contrast gastrointestinal examinations indications that certain claims of superiority for the double-contrast technique may be optimistically misleading. Analysis of reports on detection of four entities-gastric cancer, gastric ulcer, duodenal ulcer, and colonic polyps-suggests superiority for the double-contrast barium enema for detection of colonic polyps. However, no advantage for single- or double contrast examinations was demonstrable for the detection of gastric cancer, gastric ulcer, or duodenal ulcer.
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This paper explores the causes of errors on upper gastrointestinal studies. Of 129 ulcers and neoplasms seen endoscopically, 14 were unreported radiologically, representing false negative errors. The most common type of error was failure to note a lesion rendered poorly visible by an inadequate examination. Contributing technical failures included insufficient films, poor coating, poor compression films, retained food and secretions, and badly exposed films. Perceptive failures included both misinterpretation and failure to note a lesion. Among 10 false positive errors, barium between distorted folds simulating an ulcer occurred most commonly.
A study of causes of error on barium enema examinations is reported. There were 144 patients with 189 inflammatory and neoplastic lesions of the large bowel examined endoscopically and with a preceding barium enema. Twelve lesions were not reported radiologically, a false negative error rate of 6.3%. Radiographic errors included 11 polyps and 1 sigmoid carcinoma. Causes for these errors were analyzed and classified into perceptive, technical, or combined categories. Ten lesions were visible in retrospect. Five lesions, clearly visible but not noted, were due to perceptive error. Five other lesions, poorly visible due to faulty studies, represented combined error. Two lesions could not be identified and represented purely technical failure. All unreported lesions were distal to the splenic flexure with the majority located in the sigmoid colon.
Colonoscopically verified lesions (230 in 178 patients) were reviewed and compared to results of double-contrast barium enema studies performed by radiologists specifically interested in gastrointestinal disease. Eighteen carcinomas and 22 cases of colitis found endoscopically were accurately identified radiographically. In 140 patients with 190 polyps, 16 lesions were missed radiologically, a false-negative error for polyps of 8.4%. All undetected polyps were distal to the splenic flexure with the majority located in the sigmoid colon. Thus, the double-contrast barium enema study was quite effective in finding colon polyps, particularly proximal to the splenic flexure.
Controversy still exists over the anatomic configuration of the liver. Even such basic considerations as the means by which the inferior radiographic border of the liver is formed remain an enigma. This article reflects the current knowledge of the anatomy of the liver as perceived by the radiologist.
A case of pneumoperitoneum occurring during double-contrast barium enema is described. Cases reported to date indicate that colonic rupture during a double-contrast enema is likely to result in exit of air rather than barium from the colon. The diagnostic implicatons of this observation are considered. The potentially high pressure generated by bulb-type inflators is discussed, and caustion is advised against overdistending the colon during double-contrast enemas.
The areae gastricae are often visible as a structural feature of the gastric mucosa during double-contrast studies of the stomach. In this paper, radiographic visualization of the areae gastricae traversing the esophageal hiatus is described as a sign of hiatus hernia. In most instances, other radiographic signs of hiatus hernia are also present or may be elicited.