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Biomedical subjects

H Herlinger

Publications and source records attributed to H Herlinger.

At least 19 recordsLinked to original sources
PubMed1995

Giant ulcers of the esophagus in patients with human immunodeficiency virus: clinical, radiographic, and pathologic findings.

PURPOSE: To determine the causes of giant esophageal ulcers in patients with human immunodeficiency virus (HIV) and whether clinical or radiographic criteria can be used to differentiate the infections that cause these ulcers. MATERIALS AND METHODS: From January 1990 through December 1993, giant esophageal ulcers ( > or = 1 cm in diameter) were found in 21 HIV-positive patients (19 men and two women 23-66 years of age; mean, 39 years). The radiographic findings were reviewed and correlated with clinical, endoscopic, and pathologic findings. RESULTS: In 16 patients, the ulcers were caused by HIV, in three by cytomegalovirus (CMV), and in two by CMV and HIV. The clinical and radiographic findings were the same for the two types of ulcers. However, HIV ulcers responded to treatment with steroids, and CMV ulcers responded to treatment with ganciclovir. CONCLUSION: It is not possible to differentiate HIV from CMV ulcers on the basis of clinical or radiographic criteria; thus, endoscopy is necessary for a definitive diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1995

Helicobacter pylori gastritis: radiographic findings.

PURPOSE: To determine whether there are useful radiographic criteria for diagnosing Helicobacter pylori. MATERIALS AND METHODS: Radiographs from double-contrast upper gastrointestinal examinations of 88 patients with H pylori and 41 control subjects were blindly reviewed. The results were analyzed by means of receiver operating characteristic (ROC) curves. RESULTS: Thickened gastric folds were detected in 39 patients with H pylori (44%) and nine control subjects (22%). The area under the ROC curve was 0.62 (standard deviation [SD] = 0.05, P < .01). Among the 48 subjects with thickened gastric folds, polypoid gastritis with thickened, lobulated folds was detected in 24 patients with H pylori (62%) and four control subjects (44%). The area under the ROC curve was 0.59 (SD = 0.05, P < .01). No substantial differences were observed in the frequencies of gastric ulcers, erosive gastritis, gastric narrowing, duodenal ulcers, duodenitis, and duodenal narrowing in patients with and without H pylori. CONCLUSION: The presence of thickened gastric folds was the best radiographic criterion for differentiating subjects with from those without H pylori.

Adult↗
PubMed1995

Colon cancer: morphology detected with barium enema examination versus histopathologic stage.

PURPOSE: To determine the relationship between the morphology of colon carcinomas detected with barium enema examination and the cancer stage. MATERIALS AND METHODS: Clinical, radiographic, endoscopic, surgical, and histopathologic findings were retrospectively reviewed in 152 patients with colon cancer detected with barium enema examination during a 2-year period. RESULTS: Eighty-six patients (57%) had lesions in the rectum and sigmoid and descending colon, and 66 (43%) patients had lesions more proximally in the colon. Lesions on the right side of the colon were less likely to cause symptoms than those on the left side. Eighty-one patients (53%) had annular or semiannular lesions, 57 (38%) had polypoid lesions, and 14 (9%) had plaquelike or carpet lesions. Six patients (4%) had Dukes stage A lesions; 84 (55%), Dukes stage B lesions; 42 (28%), Dukes stage C lesions; and 20 (13%), Dukes stage D lesions. CONCLUSION: Annular or semiannular carcinomas had higher rates of serosal invasion and lymph node metastasis than polypoid carcinomas, but the rates of liver metastases were comparable.

Adenocarcinoma↗
PubMed1995

Guide to imaging of the small bowel.

The small intestine is a difficult organ to image. Its considerable length, the changing location of its many overlapping coils, and the often adverse effect of luminal fluids on the coating ability of barium necessitate the use of special techniques employing special barium formulations.

Barium Sulfate↗
PubMed1994

Diagnosis of gastric carcinoma: sensitivity of double-contrast barium studies.

OBJECTIVE: This study was undertaken to determine if the double-contrast upper gastrointestinal examination is a sensitive technique for diagnosing gastric carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the radiographs of 80 patients with pathologically proved gastric carcinoma who had double-contrast barium studies of the upper gastrointestinal tract between 1985 and 1992. The original radiologic reports were also reviewed to determine if the lesions had been detected on radiographic studies and if a diagnosis of gastric carcinoma had been made or suspected on the basis of the results. Subsequently, radiologic records were reviewed to identify all patients who had double-contrast studies during a recent 1-year period for whom endoscopy was recommended for evaluation of possibly malignant lesions. Pathologic records were also reviewed to determine the number of true-positive and false-positive cases in this group. RESULTS: The lesions were detected radiographically in all 80 patients. In one case, however, the lesion had been missed on another barium study 2 years earlier, so that we actually detected 79 (99%) of the 80 gastric carcinomas. Malignant neoplasm was diagnosed or suspected in 77 cases (96%). In two of the three cases in which gastric carcinoma was not mentioned in the radiologic reports, the lesion caused gastric outlet obstruction. A separate 1-year retrospective review revealed that only 54 (3.5%) of 1546 patients who had double-contrast studies during this period were referred for endoscopy because of radiographic findings that were equivocal or suggestive of tumor. The presence of gastric carcinoma was confirmed by endoscopy or surgery in 10 (19%) of those 54 patients. CONCLUSION: Our findings indicate that the double-contrast upper gastrointestinal examination is a sensitive technique for the diagnosis of gastric carcinoma. Furthermore, a high sensitivity can be achieved without having an inordinate number of patients undergo unnecessary endoscopy.

Adenocarcinoma↗
PubMed1994

Enteroclysis in the evaluation of obscure gastrointestinal bleeding.

OBJECTIVE: The diagnostic yield of enteroclysis was retrospectively evaluated for patients with obscure bleeding from the gastrointestinal tract. MATERIALS AND METHODS: A total of 128 patients with obscure gastrointestinal bleeding were referred to our department for enteroclysis between 1988 and 1993. The original radiologic reports were reviewed to determine the radiographic findings in these patients. The radiographic findings then were correlated with medical, surgical, and pathologic findings. RESULTS: Thirty-two patients had lesions found at enteroclysis. Nineteen of those patients had confirmation of the radiographic diagnosis, primarily by pathologic examination of the surgical specimen. Five other patients were found at surgery to have had false-positive diagnoses at enteroclysis. Eight patients ceased to bleed without pathologic corroboration, but their clinical presentation and course supported the radiographic diagnosis. Thus, 27 (21%) of the 128 patients had confirmed or highly probable lesions seen at enteroclysis as the cause of obscure gastrointestinal bleeding. Seventeen patients (13%) had tumors involving the small bowel, and three (2%) had arteriovenous malformations in the jejunum. CONCLUSION: This study corroborates earlier reports that enteroclysis is a useful diagnostic test for examining the small intestine in patients with obscure gastrointestinal bleeding.

Adult↗
PubMed1993

Polypoid lesions at the anorectal junction: barium enema findings.

Although the anorectal junction is easily accessible, this area may be difficult to evaluate both radiologically and endoscopically because it is relatively collapsed. This pictorial essay illustrates the barium enema radiographic findings and reviews the radiologic and endoscopic pitfalls in the diagnosis of lesions of the anorectal junction.

Adenocarcinoma↗
PubMed1992

Cytomegalovirus gastritis: protean radiologic features.

Infection with cytomegalovirus (CMV) is a major feature of acquired immunodeficiency syndrome (AIDS). Gastrointestinal involvement is being seen more frequently. Our collective experience involves nine patients with stomach involvement. Seven patients were intravenous drug abusers or homosexuals with AIDS. One developed CMV gastritis as a complication of leukemia and one patient was a West African with lymphoma and human immunodeficiency virus (HIV) infection. All our patients had biopsy-proven CMV inclusion bodies. The radiographic appearances varied widely. The findings included markedly thickened edematous folds, erosive gastritis with aphthous ulceration, and superficial and deep ulceration. One patient had deep ulceration with fistula formation. Computed tomographic (CT) scans confirmed the greatly thickened gastric wall and coarsened folds in two patients. Associated gastrointestinal infections included candida and herpes, and, in addition, pneumocystis carinii pneumonia (PCP) was present in two patients. CMV gastritis may mimic several other conditions including erosive gastritis, peptic ulceration, lymphoma, and carcinoma. It should be strongly considered in immunosuppressed patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Focal spiculation of the upper thoracic esophagus: normal variant at double-contrast esophagography.

A review of 100 routine biphasic upper gastrointestinal examinations revealed focal spiculation of the upper thoracic esophagus as a transient finding in 11 patients (11%) who otherwise had no clinical or radiographic signs of esophageal disease. All 11 patients had remarkably similar findings, with thin (1-2 mm wide), transverse folds or striations above the level of the aortic arch, producing a spiculated or serrated appearance in profile. This focal spiculation should be considered a normal variant in the esophagus on double-contrast radiographs. It is suspected that this phenomenon is related to weakening of peristalsis or localized contraction of the longitudinally oriented muscularis mucosae at the junction of the striated- and smooth-muscle portions of the esophagus. Whatever the explanation, radiologists should be familiar with this finding, so that it is not mistaken for a focal area of esophagitis.

Adolescent↗
PubMed1991

Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients.

Initial observation and evaluation of patient progress have reduced the number of operative interventions in the management of small intestinal obstruction. The differentiation of simple mechanical from strangulating obstructions has remained difficult. Strangulation is not an invariable component of a closed loop obstruction. We report 27 patients with small bowel obstruction initially managed nonsurgically, in whom enteroclysis 2-8 days after admission demonstrated unsuspected closed loop obstruction. In 25 of the 27 patients, subsequent surgery confirmed the radiologic diagnosis: all the obstructed loops were viable and there was no operative mortality. Our experience suggests that the early performance of enteroclysis should be considered in patients with small bowel obstruction undergoing a trial of nonoperative management.

Adolescent↗
PubMed1991

Radiologic features of closed loop obstruction: analysis of 25 confirmed cases.

The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.

Adolescent↗