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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 19 recordsLinked to original sources
PubMed1997

Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis.

OBJECTIVE: The purpose of this study was to determine the sensitivity of barium studies in revealing carcinoma of the esophagus and esophagogastric junction. MATERIALS AND METHODS: We retrospectively reviewed 50 cases of squamous cell carcinoma of the esophagus (n = 25) and adenocarcinoma of the esophagus (n = 14) or esophagogastric junction (n = 11) in which double-contrast (n = 46) or single-contrast (n = 4) barium studies had been done. The original radiology reports were reviewed to determine whether the lesions had been seen on barium studies and whether cancer had been diagnosed. Records were also reviewed to determine the number of patients who underwent esophageal endoscopy because of findings suggestive of cancer on barium studies at some point from January 1992 through December 1992. Pathology records were then reviewed to determine the number of true- and false-positive barium studies during this same period. RESULTS: Lesions were shown on barium studies in 49 (98%) of 50 patients, and carcinoma of the esophagus or esophagogastric junction was diagnosed or suspected in 48 patients (96%). In a separate part of the study, we found that endoscopy had been recommended to rule out malignant tumor in only 26 (1%) of 2484 patients who underwent barium studies at some point from January 1992 through December 1992. Endoscopy revealed cancer in 11 of those 26 patients; the remaining 15 were assumed to have false-positive radiologic examinations. Barium studies therefore had a positive predictive value of 42%. CONCLUSION: The double-contrast barium study is a sensitive technique for the diagnosis of carcinoma of the esophagus and esophagogastric junction. This high sensitivity can be achieved while recommending endoscopy in only about 1% of all patients who undergo barium studies.

Adenocarcinoma↗
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

The effects of distention of the colon during air-contrast barium enema on colonic morphology: anatomic correlation.

Radiologic and pathologic findings are snapshots of disease processes that may vary with a host of dynamic variables. This pictorial essay shows how the presence and visibility of the innominate grooves of the colon are a function of colonic distention. This article also shows how each layer of the colonic wall, including the epithelium, muscularis mucosae, and muscularis propria, changes dramatically in thickness with varying degrees of colonic distension. These anatomic changes are documented by barium enema radiography, specimen radiography, dissecting photomicrography, and histology. These observations have important implications for the interpretation of radiologic and pathologic findings in both normal and diseased states.

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

Gastrocolic fistulas: the increasing role of aspirin.

Eight patients had gastrocolic fistulas depicted on barium studies at the authors' hospital during a 10-year period between 1982 and 1992. Seven of those patients (88%) had benign disease, including aspirin-induced gastric ulcers of the greater curvature (n = 4), granulomatous colitis (n = 1), tuberculosis (n = 1), and a penetrating anastomotic ulcer after partial gastrectomy (n = 1). The remaining patient had a malignant gastrocolic fistula caused by carcinoma of the transverse colon. Two patients (25%) experienced classic symptoms of gastrocolic fistulas (ie, feculent vomiting or foul-smelling eructations), but the other six (75%) experienced abdominal pain or other nonspecific clinical findings. In the four patients who were taking aspirin, upper gastrointestinal examinations revealed giant penetrating ulcers of the greater curvature that communicated with the superior border of the transverse colon via a fistula. Three of these patients exhibited marked clinical improvement after conservative medical treatment and did not need surgery. This experience suggests that aspirin-induced gastric ulcers of the greater curvature have become a more common cause of gastrocolic fistulas than is carcinoma of the stomach or transverse colon.

Adult↗
PubMed1993

Delayed leaks and fistulas after esophagogastrectomy: radiologic evaluation.

OBJECTIVE: Although breakdown of the esophagogastric anastomosis often occurs as a complication of esophagogastrectomy during the early postoperative period, it is not well recognized that anastomotic leaks and fistulas may occur during the late postoperative period (more than 1 month after surgery). The purpose of our study was to determine the radiologic appearance and clinical significance of these late leaks and fistulas. MATERIALS AND METHODS: A review of radiology records at our hospital from 1985 to 1991 revealed 37 patients who had upper gastrointestinal contrast studies an average of 13.3 months after esophagogastrectomy. RESULTS: Six patients (16%) had anastomotic leaks or fistulas that occurred during the late postoperative period. Four patients were asymptomatic; three had contrast studies that showed thin, blind-ending tracks extending from the anastomosis into the mediastinum, and the fourth had an esophagogastric fistula. One of the blind-ending tracks later progressed to a gastropleural fistula that was treated with antibiotics and drainage. One symptomatic patient had a gastropleural fistula, and the other had a gastrobronchial fistula. Both fistulas were surgically repaired. None of the leaks or fistulas was associated with recurrent tumor. CONCLUSION: Anastomotic leaks or fistulas may be detected on contrast studies obtained more than 1 month after esophagogastrectomy. Some leaks appear as blind-ending tracks that have no clinical significance, but others may be manifested by life-threatening gastropleural or gastrobronchial fistulas that necessitate surgical intervention.

Bronchial Fistula↗
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↗
PubMed1993

The upper gastrointestinal series at a crossroads.

Radiologic examination of the upper gastrointestinal tract, or the upper gastrointestinal series, is at a crossroads. As we approach the 21st century, it is possible to envision two very different scenarios for the future of this examination. The gradual but steady decline in the number of upper gastrointestinal studies done during the past decade could continue or even accelerate until this technique is no longer used in diagnostic radiology. Or, spurred by new concerns about cost and safety in a rapidly changing political and economic environment, the upper gastrointestinal series could undergo a dramatic resurgence, supplanting endoscopy as the primary diagnostic test in patients with symptoms in the upper gastrointestinal tract. Radiologists may ultimately have a pivotal role in determining the fate of the upper gastrointestinal series by their commitment or lack of commitment to perpetuating this form of examination. In this article, we consider the status of the upper gastrointestinal series in current medical practice and the challenges we face if it is to remain a useful diagnostic technique in the 21st century.

Digestive System↗
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↗
PubMed1992

Optimizing gallbladder stone lithotripsy: an international survey.

Rates of stone clearance with extracorporeal shock wave cholecystolithotripsy (biliary lithotripsy [BL]) initially reported by European groups were encouraging. An American multicenter BL study (the Dornier National Biliary Lithotripsy Study [DNBLS]) did not reproduce these results. The BL treatment strategies and 6-month stone clearance rates of six leading European and Japanese centers were compared with those of DNBLS. All foreign centers used adjuvant oral chemolitholysis and greater shock wave energies from the same lithotriptor as that in DNBLS. Six months after BL, the stone clearance rates at all six centers were higher than those of DNBLS. There were no significant differences in complication rates between centers. These findings suggest that the poor results of DNBLS were chiefly due to the use of low kilovoltage and few BL sessions. Increased energy levels and a fragment size end point of less than 5 mm optimize BL. Despite the popularity of laparoscopic cholecystectomy, BL can be recognized as a successful treatment alternative for patients with a low burden of radiolucent stones.

Cholelithiasis↗
PubMed1991

Pictorial review: principles of double-contrast pharyngography.

This pictorial essay will explain how to obtain quality double- contrast radiographs during pharyngography, present principles of the interpretation of double-contrast images of the pharynx, and show examples of benign and malignant pharyngeal tumors.

Adult↗