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Biomedical subjects

H Herlinger

Publications and source records attributed to H Herlinger.

At least 55 records · Page 3Linked to original sources
PubMed1989

Rectal involvement by prostatic carcinoma: barium enema findings.

A retrospective study was performed to determine the radiographic features of prostatic carcinoma invading the rectum on double-contrast barium enemas. In 11 such patients, these examinations revealed localized narrowing and/or speculation of the rectum (four cases); a smooth, extrinsic mass impression on the rectosigmoid colon (two cases); an umbilicated submucosal mass in the rectosigmoid colon (one case); and rectosigmoid narrowing with spiculated, pleated mucosal folds in the narrowed segment of bowel (four cases). Thus, most patients (64%) had localized involvement of the rectosigmoid colon with sparing of the distal rectum. The anatomic-pathologic basis for the localized spread of prostatic carcinoma to the rectosigmoid colon is illustrated on MR scans. Thus, prostatic carcinoma invading the rectum may be manifested on double-contrast barium enema by a spectrum of radiographic findings, and most patients have localized rectosigmoid involvement with sparing of the distal rectum.

Adenocarcinoma↗
PubMed1988

Association of Meckel's diverticulum and Crohn's disease.

A significant association between Meckel's diverticulum and Crohn's disease has been suggested in the clinical literature. Ten patients with entities demonstrated radiographically as well as cases reported in the literature were analyzed to determine the relevance of this association to radiologic evaluation. The Meckel's diverticulum in most cases was an incidental finding whereas the Crohn's disease usually accounted for the patient's clinical symptoms. Recognition of this association should prevent unnecessary laparotomy for an incidental Meckel's diverticulum and improve the radiographic diagnosis of coexistent Crohn's disease.

Adult↗
PubMed1988

Metoclopramide-ceruletide assisted small bowel examination.

We investigated the feasibility of performing a combined upper gastrointestinal and small bowel examination. Metoclopramide was given at the start of the examination and ceruletide was injected to hasten small bowel transit. The quality and duration of fifty examinations (Group I) was compared to that of fifty patients receiving metoclopramide alone (Group II) and fifty patients undergoing unaided examinations (Group III). The mean duration of the entire study was 29.3 minutes for Group I patients, 37.6 minutes for patients in Group II and 69.1 minutes for Group III subjects. The combination of agents produced contracted fold patterns in the jejunum and ileum that rendered individual loops more accessible to individual study under fluoroscopy in approximately 50% of subjects.

Barium Sulfate↗
PubMed1988

Barrett's esophagus: diagnosis by double-contrast esophagography.

A blinded, retrospective study was performed to determine the role of double-contrast esophagography in diagnosing Barrett's esophagus. The study group consisted of 200 patients who had double-contrast esophagrams and endoscopy because of severe reflux symptoms. The radiographs were reviewed by two gastrointestinal radiologists who had no knowledge of the endoscopic findings. Patients were classified as being at high risk for Barrett's esophagus if the radiographs revealed a high stricture or ulcer or a reticular mucosal pattern; at moderate risk if the radiographs revealed a distal peptic stricture and/or reflux esophagitis; and at low risk if none of the aforementioned findings were present. When these radiologic criteria were used, 10 patients (5%) were thought to be at high risk, 73 (37%) at moderate risk, and 117 (58%) at low risk for Barrett's esophagus. Endoscopic correlation revealed biopsy-proved Barrett's mucosa in nine (90%) of 10 patients at high risk, in 12 (16%) of 73 at moderate risk, and in only one (1%) of 117 at low risk for Barrett's esophagus. Thus, endoscopy is clearly indicated for patients in the high-risk group. Because of the lower prevalence of Barrett's esophagus in the moderate-risk group, clinical judgment should be used in deciding when to perform endoscopy in these patients. However, most patients were in the low-risk group, and the prevalence of Barrett's esophagus was so low in this group that endoscopy does not appear to be warranted. Thus, the major value of double-contrast esophagography is its ability to separate patients into high-, moderate-, and low-risk groups for Barrett's esophagus to determine the relative need for endoscopy and biopsy.

Adenocarcinoma↗
PubMed1988

Herpes esophagitis: sensitivity of double-contrast esophagography.

During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.

Adult↗
PubMed1987

Annular malignancies of the small bowel.

True annular malignancies of the small bowel with mucosal destruction and shelflike margins are generally thought to be caused by primary adenocarcinoma. At our institution, 18 annular malignancies were diagnosed radiographically in the small bowel by enteroclysis (16 cases) and conventional small bowel follow-through studies (2 cases) between 1977 and 1984. However, pathologic data revealed only 4 primary adenocarcinomas with 10 metastatic lesions (6 colon cancers, 2 malignant melanomas, 1 lung cancer, and 1 cervical cancer), 2 leiomyosarcomas, 1 non-Hodgkin's lymphoma, and 1 malignant carcinoid tumor. While these lesions may be indistinguishable radiographically, annular carcinomas tended to be short, relatively nonobstructing lesions; annular metastases (except those from malignant melanoma) tended to be highly obstructing lesions with significant narrowing and/or angulation of the bowel. Leiomyosarcomas, lymphoma, and metastases from malignant melanoma tended to be longer lesions with extensive ulceration, wider channels, and little or no evidence of obstruction. Nevertheless, surgical resection or biopsy of the lesion is ultimately required for a definitive diagnosis.

Adenocarcinoma↗
PubMed1987

Benign gastric ulcers: diagnosis and follow-up with double-contrast radiography.

Double-contrast upper gastrointestinal examinations revealed 108 gastric ulcers at the authors' hospital during a recent 1-year period. With use of current double-contrast examination criteria for differentiating benign and malignant ulcers, the radiographic appearance was unequivocally benign in 68 patients, probably benign in 25, probably malignant in 12, and unequivocally malignant in three. Fifty-six patients with benign, probably benign, or probably malignant ulcers underwent endoscopy and biopsy. All 56 had benign ulcers. Another three patients with unequivocally malignant ulcers had endoscopically proved carcinomas. Thus, most suspicious ulcers were benign, but no benign-appearing ulcers were malignant. Follow-up double-contrast studies for 87 ulcers revealed complete ulcer healing in 68 (78%). A residual ulcer scar was observed in 61 of those 68 cases (90%). This experience suggests that double-contrast radiography is a valuable technique for diagnosing benign gastric ulcers and that once diagnosed, typically benign ulcers can be followed up radiographically until completely healed, without need for endoscopic intervention.

Contrast Media↗
PubMed1987

Opportunistic esophagitis in AIDS: radiographic diagnosis.

Thirty-five of 90 patients with acquired immunodeficiency syndrome (AIDS) seen between 1983 and 1986 underwent esophagography (double contrast in all but two) to rule out opportunistic esophagitis; 20 of the 35 were found to have fungal or viral esophagitis. A radiographic diagnosis of Candida esophagitis was made in 17 patients because of varying degrees of plaque formation. Seven of those patients had a grossly irregular or "shaggy" esophagus; in four, the diagnosis of AIDS was initially suspected from this finding. In the remaining three patients, a radiographic diagnosis of viral esophagitis (herpes simplex in two and cytomegalovirus in one) was made because of discrete ulcers on a normal background mucosa. Eighteen patients had endoscopic, clinical, or autopsy findings that corroborated the radiographic diagnosis; follow-up data were not available for two patients with Candida esophagitis. This experience suggests that fungal and viral esophagitis can often be differentiated with double-contrast esophagography, enabling appropriate antifungal or antiviral therapy to be instituted without endoscopic intervention.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Gastrointestinal tract focal mass lesions: role of CT and barium evaluations.

Fifty-eight patients with focal mass lesions involving the gastrointestinal tract were studied retrospectively. The diagnostic value of CT scans was seen by assessing the barium studies alone, then by combined review of radiographs and CT scans. Patient management decision making was similarly evaluated. CT scanning aided in diagnosis of the focal masses in 17 patients (29%), changing the differential diagnosis in eight (14%) and increasing diagnostic confidence significantly in nine (16%). In 21 (36%) additional cases, the diagnosis did not change, but CT scanning improved the understanding of disease extent. In the remaining 20 cases (34%), CT scanning did not help diagnostically. CT scanning altered patient management decisions in 19 of the 58 patients (33%). CT study was most helpful in cases of benign extrinsic cystic disease, lymphoma, and smooth-muscle tumors and less helpful for adenocarcinomas of the bowel. The value of the CT data increased as one moved from mucosal lesions to submucosal or extrinsic lesions.

Adenocarcinoma↗
PubMed1986

Jejunal fold separation in adult celiac disease: relevance of enteroclysis.

The number of folds in the proximal jejunum was measured retrospectively in 25 studies of patients with adult celiac disease and 75 control subjects. The average number of folds per inch of proximal jejunum in the group with celiac disease was 2.88 (none to five), as against 4.88 (three to seven) in the controls. The difference was less pronounced in the distal ileum. A "mosaic pattern" was demonstrated in three patients. Positive radiologic evidence of celiac disease could be elicited in 76% of the patients' studies. Demonstration of five or more folds in the jejunum and/or three or fewer folds in the ileum would have been evidence against a diagnosis of celiac disease in 67 of the 75 controls. Indications for the use of radiography in celiac disease are reassessed.

Barium↗
PubMed1986

Pseudomembranes in reflux esophagitis.

Three cases are presented in which double-contrast esophagograms revealed one or more plaquelike lesions in the distal esophagus, representing pseudomembrane formation in patients with severe reflux esophagitis. Although to our knowledge this finding has not been reported previously in the radiologic literature, pseudomembranes have been documented endoscopically in patients with reflux esophagitis and biopsy-proved Barrett esophagus. Radiologists should be aware of this finding, since these pseudomembranes may be indistinguishable radiographically from plaquelike carcinomas arising in Barrett esophagus.

Adult↗
PubMed1986

Nonspecific involvement of bowel adjoining Crohn disease.

Nonspecific changes in bowel segments adjacent to areas of Crohn disease were identified radiographically in 12 patients. In eight patients such changes were related to fistulization; in four patients they were due to close proximity of an inflammatory mass, abscess, or phlegmon of Crohn disease origin. The radiographic feature of nonspecific involvement was focal fold thickening, either in relation to the site of entry of fistulas or, together with mass effect, in response to the extrinsic inflammatory process. Radiographic differentiation of nonspecific bowel changes from actual Crohn disease is possible and is relevant to management, since nonspecific changes revert to normal once the underlying Crohn disease has been resected. Preoperative identification of nonspecificity supports a more conservative approach to surgery in patients with Crohn disease.

Adult↗
PubMed1986

The effect of barium suspension viscosity on the delineation of areae gastricae.

The viscosity of a barium suspension is an important and controllable variable that influences the quality of mucosal detail demonstrated by double-contrast upper gastrointestinal examination. High-density barium suspensions show a notable viscosity response to seemingly trivial changes in the amount of water added. A double-blind trial involving 600 patients used E-Z-HD of the same batch number suspended with 65-70 ml water. Overall, areae gastricae covering at least 25% of the stomach surface were seen in 68.3%; no or minimal areae gastricae were seen in 31.7%. The corresponding figures for the suspension of optimal viscosity were 80% and 20%, respectively.

Barium Sulfate↗
PubMed1986

Esophageal intramural pseudodiverticulosis: a reevaluation.

Esophageal intramural pseudodiverticulosis is an unusual condition manifested by tiny flask-shaped outpouchings in the wall of the esophagus. The condition was diagnosed in 21 (0.15%) of 14,350 patients undergoing radiologic examinations of the esophagus at our hospitals. The pseudodiverticula were detected only by single-contrast technique in five of 18 patients (28%) who underwent both single- and double-contrast examinations. Thus, thin, low-density barium seems to enter these structures more readily than the high-density barium used for double-contrast esophagography. While most patients reported in the literature have diffuse or segmental pseudodiverticulosis associated with high esophageal strictures, the majority of our patients (11 [52%] of 21) had isolated involvement of the distal esophagus with 10 or fewer pseudodiverticula in the region of a peptic stricture. Other associated conditions included Candida esophagitis, herpes esophagitis, and squamous cell carcinoma of the esophagus. Our experience suggests that pseudodiverticulosis usually represents a sequela of reflux esophagitis, although the reason that so few patients with esophagitis develop this condition is unclear.

Adult↗