Biomedical subjects
Publications and source records attributed to G Schmutz.
Henoch's purpura involve often the small intestine. These involvement are rarely visualised by radiology. They consist of submucosal edema with thickening of the folds and hematoma with intramural thumbprints on the mesenteric border. The lesions are segmental. The disease process is reversible and healing is complete without stenosis or fibrosis.
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The authors describe the radiological features of a patient with Behcet's disease, who had oesogastric ulcers and a terminal ileitis as major part of this clinical syndrome. The radiologic appearance of these localisations are discussed. The similarities of Behcet's disease to Crohn's disease are outlined.
We have performed 131 double contrast barium enemas in 81 cases of granulomatous colitis or ileocolitis. 53 cases showed "early lesions": Inflammatory mucosa, lymphoid hyperplasia, aphtoid or varioliform ulcers and primary complexes. In 39% "early lesions" were the only granulomatous lesions of the colon. Several types of "early lesions" may appear in the same patient. 18 patients were subjected to a series of double contrast barium enemas. The lesions progressed in 12 cases and regressed in 6 cases. "Early lesions" may develop into segmental coblestone pattern. The radiological findings were confirmed by endoscopy or operation in 91% of our cases. A perfect double contrast barium enema is necessary to detect these "early lesions" which are important for diagnosis, treatment and possibly even for the prognosis in this disease.
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The authors have performed 150 double contrast small bowel enema. The results of 32 radiological examinations in Crohn's disease are reported. Four elementary alterations of the mucosal pattern can be described:--folding modifications,--mucosal defects,--different ulcers,--association between defects and ulcers drawing the classic "cobblestone" pattern. The transmural lesion is evident by fistules, strings, dilatations and mesenteric retractions. The conventionnal radiologic examination of the small bowel is satisfactory to show the manifestations of transmural lesion; but the double contrast enema is clearly more performing to characteristic mucosal lesions. So it appears indispensable to use this method for exploration of every Crohn's disease, to complete the conventionnal repletion enema.
Observation of a 52 years old man who is treated by anticoagulant who presents a subocclusive syndrome caused by an intramural hematoma of ileum. The radiological features are described in double contrast. Interest of the double contrast intestinal transit is discussed.
A recurrent ulcerative colitis in a Behcet's disease. The radiological features of this colitis are studied by a follow up of double contrast baryum enema. The diagnostic with Crohn's colitis is discussed.
The authors have performed barium enema in 22 cases of non gangrenous ischaemic colitis. The diagnosis was established on the clinical, endoscopic and radiological data. The barium enema's radiological features and their evolution are described in particular thumbprinting, ulcerations, stenosis and sacculations. All these radiological signs were confirmed by endoscopic investigation or pathological examination. Abdominal angiography are carried out in 10 cases. The preferential site of the lesions is the descending colon. The differential diagnosis with other colitis are discussed and the diagnosis is easier when the barium enema is performed soon.
A 50 years old man with clinical manifestations of intestinal ischemia associated with malabsorption. On abdominal angiography an obstruction of the 3rd jejunal artery is seen. Barium meal revealed a diffuse jejunopathy with disappearance of mucosal folds and intestinal biopsy showed a complete loss of villi.
Double contrast radiological features of thirty eight small esophageal carcinoma are described. Double contrast study is essential in the detection of small esophageal carcinomas: localized thickening of the folds (29%), localized wall stiffness (23.6%), superficial ulcers (13%), discrete superficial nodule (42%), nodularity (15.7%), and ulcerated nodule (15.7%). In our series, six carcinomas arising from reflux esophagitis have the nodular appearance. As in the majority of the cases, small esophageal carcinomas are asymptomatic, when radiologic study of esophagus is performed in patients over 40 years with heavy alcohol and tobacco use, it is imperative to use the double contrast method and to carefully search for minor mucosal abnormalities.
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The alimentary tract often contains some gas which may obstruct the passage of the ultrasonic beam. However, when a pathological process involves the intestinal wall, a "target" pattern or a "pseudo-kidney" pattern may be visualized by ultrasound. It is also possible to visualize by US examination some complications of Crohn's disease: intestinal obstructive lesion with distended loops, fistula, abscesses and renal or biliary lithiasis. Because sonography is non-invasive and simple to perform without radiation exposure, it should often be used in Crohn's disease as the initial diagnosis and as the following-up test.
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The case of a granular cell tumor of the lower esophagus associated with a bronchial carcinoma is reported. The esophageal tumor was discovered by radiological and endoscopic examination for symptoms of gastroesophageal reflux and caused dysphagia after 6 1/2 years. An associated bronchial carcinoma led to the endoscopic removal of the esophageal tumor immediately prior to the thoracotomy. Eight days after operation the patient presented an hematemesis probably related to the endoscopic polypectomy. The course can be considered favorable after 17 months concerning the esophageal as well as the pulmonary situation. Histologically the esophageal tumor was a typical granular cell tumor and the bronchial tumor a squamous cell carcinoma. Seventy-nine cases of granular cell tumors of the esophagus have been published; 10 p. 100 of the cases are associated with bronchial, digestive or otorhinolaryngeal carcinoma. The onset of the carcinoma is usually subsequent to the esophageal tumor, justifying prolonged surveillance. This is the third case of a granular cell tumor of the esophagus treated by endoscopic polypectomy; this type of treatment requires close short-term follow-up because of the risk of hemorrhage as well as long-term follow-up because of the possibility of a second esophageal localization.
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The authors had examined by double contrast barium enema in 115 cases of Crohn's ileo-colitis. They described the radiological double contrast features. The "early lesions" are always surrounded by a healthy-looking mucosa. The advanced lesions are segmentary: shallow limited ulcers, shallow confluent ulcers, cobblestone pattern and nodular pattern. Several types of lesions may appear in the same patient. The distribution of the lesions is asymmetrical with skip areas and gradual size of the lesions. The parietal lesions are well demonstrated by double contrast, especially the sacculations. Our radiological findings are confirmed by endoscopical features and excised specimens in 100 cases. A double contrast barium enema is necessary to well described the lesions especially the "early lesions" which are important for differential diagnostic, with ulcerative colitis, for surgical treatment in evaluating the extend of the disease and possibly even for prognosis in this disease.