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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 73 records · Page 4Linked to original sources
PubMed1991

Giant, human immunodeficiency virus-related ulcers in the esophagus.

Human immunodeficiency virus (HIV) infection of the esophagus has recently been implicated as a cause of giant esophageal ulcers in HIV-positive patients with odynophagia. The authors examined four patients in whom esophagograms (one single-contrast and three double-contrast studies) revealed giant, HIV-related ulcers indistinguishable from those of cytomegalovirus (CMV) esophagitis. All four patients had severe odynophagia, one had an associated maculopapular rash, and two became HIV-positive at approximately the time of clinical presentation. In all patients, biopsy samples, brushings, and cultures obtained with endoscopy were negative for CMV or herpes simplex. One patient had positive brushings for candidiasis, but this may have resulted from fungal superinfection of the ulcer. Two patients were treated with orally administered steroids, and all four had swift clinical improvement; symptoms disappeared during an average period of 8.3 days from presentation. HIV-related esophageal ulcers should be distinguished from CMV ulcers, so that appropriate treatment can be initiated in these patients.

Adult↗
PubMed1991

Diagnosis of pneumoperitoneum on supine abdominal radiographs.

A blinded, retrospective study was performed to determine the value of supine abdominal radiographs in diagnosing pneumoperitoneum. Supine films from 44 cases of pneumoperitoneum were randomly interspersed among supine films from 87 control subjects without free air, and the films were reviewed for the presence or absence of various signs of pneumoperitoneum, including Rigler's sign (gas on both sides of the bowel wall), the falciform ligament sign (gas outlining the falciform ligament), the football sign (gas outlining the peritoneal cavity), the inverted-V sign (gas outlining the medial umbilical folds), and the right-upper-quadrant gas sign (localized gas in the right upper quadrant). One or more of these signs were present in 26 cases (59%) of pneumoperitoneum, including the right-upper-quadrant gas sign in 18 cases (41%), Rigler's sign in 14 cases (32%), and the falciform ligament and football signs in one case each (2%). Unfortunately, there were frequent errors in the interpretation of the right-upper-quadrant gas sign and Rigler's sign, with a total of 11 false-positive cases (13%). Further analysis of the true-positive right-upper-quadrant gas signs showed that these gas collections were always triangular or linear with an inferolateral to superomedial orientation and, if triangular, a concave superolateral border. In the true-positive Rigler's signs, the bowel wall thickness ranged from 1 to 8 mm, whereas the false positives all had a bowel wall thickness of 1 mm or less. Proper interpretation of the various signs of pneumoperitoneum on supine films should lead to more accurate diagnosis of this condition.

False Positive Reactions↗
PubMed1991

Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation.

Total gastrectomy and esophagojejunostomy is an increasingly common operation that is associated with a variety of early and late postoperative complications. Between 1980 and 1990, 26 patients at our hospital who underwent this surgery (19 Roux-en-Y esophagojejunostomies and seven loop esophagojejunostomies) had postoperative upper gastrointestinal studies with water-soluble contrast material or barium. The studies were performed during the early postoperative period (within 30 days after surgery) in seven patients, the late postoperative period (more than 30 days after surgery) in seven patients, or both in 12 patients. Five patients (19%) had anastomotic leaks, four involving the esophagojejunal anastomosis and one the blind-ending jejunal limb. Five patients (19%) had transient narrowing of the esophagojejunal anastomosis during the early postoperative period, probably due to acute postoperative edema and spasm. Six patients (23%) had narrowing of the esophagojejunal anastomosis during the late postoperative period due to anastomotic strictures (three patients) or recurrent tumor (three patients). Alkaline reflux esophagitis was found in three (43%) of seven patients who had a loop esophagojejunostomy. However, two (11%) of 19 patients with a Roux-en-Y esophagojejunostomy had relatively long strictures in the distal esophagus, apparently due to scarring from alkaline reflux esophagitis. Two patients (8%) had an afferent loop obstruction due to metastatic tumor and postsurgical scarring. Radiologists need to be familiar with the normal postoperative radiologic appearances and the radiologic findings of early and late complications associated with this procedure.

Adult↗
PubMed1991

Gallstone imaging: getting the most out of the oral cholecystogram.

The introduction of "nonoperative" treatment alternatives to elective cholecystectomy (extracorporeal shock wave lithotripsy, contact dissolution of stones, and improved oral bile salts solvents) has reinstated the oral cholecystogram as an important diagnostic test providing structural and functional information on the status of the gallbladder. The basic principles involved in the proper performance and interpretation of the oral cholecystogram are reviewed from the perspective of the clinician who orders the test and makes management decisions based on its results.

Cholecystography↗
PubMed1991

Diagnosis and imaging of gastrointestinal tract cancers.

Recent trends in the diagnosis and imaging of cancers of the gastrointestinal tract include developments in screening for colorectal cancer and innovations in ultrasonography and magnetic resonance imaging of primary and metastatic hepatic tumors. Mathematical models suggest that screening for colorectal cancer will be as cost-effective as several other widely accepted screening programs, including the Papanicolaou smear for cervical cancer and screening mammography. There is considerable discussion regarding the relative roles of procedures such as fecal occult blood testing, sigmoidoscopy, colonoscopy, and radiology in screening strategies. The issue remains unsettled. In ultrasonography, the use of intraoperative ultrasound allows for the detection of more metastatic lesions in the liver than do preoperative computed tomography and ultrasound. Esophageal endoscopic ultrasonography has been used for the preoperative assessment of depth of invasion by esophageal cancer. The technique is limited in cases of stenotic cancer in which the endoscope cannot be passed through the lesion. Similarly, endorectal ultrasound can be used for staging of rectal cancer. Color Doppler ultrasound has been used for the evaluation of blood flow in relationship to hepatic neoplasms. Magnetic resonance imaging has been used not only for detecting liver tumors but also for differentiating between neoplasm and hemangioma.

Diagnostic Imaging↗
PubMed1990

Nonvisualized gallbladder on oral cholecystography: implications for lithotripsy.

Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with non-visualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy.

Cholecystography↗
PubMed1990

Isolated gastric varices: splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.

Diagnosis, Differential↗
PubMed1990

Non-Hodgkin lymphoma of the small intestine.

The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.

Adult↗
PubMed1990

Scirrhous carcinoma of the stomach: radiologic and endoscopic diagnosis.

During a recent 10-year period, scirrhous tumors of the stomach were diagnosed at upper gastrointestinal examinations in 27 patients in whom pathologic correlation was available. Nineteen patients underwent double-contrast studies, and eight underwent single-contrast studies. Twenty-two of the 27 patients had primary gastric carcinoma, four had gastric involvement by metastatic breast cancer, and one had antral gastritis and scarring without evidence of malignancy. Although the involved gastric segment often demonstrated only mild loss of distensibility, the presence of a scirrhous tumor was suggested radiographically by distortion of the normal surface pattern of the stomach with mucosal nodularity, spiculation, ulceration, and/or thickened, irregular folds. Ten patients had localized lesions involving the gastric fundus and/or body rather than the classic form of linitis plastica involving the distal stomach. Furthermore, endoscopy had significant limitations in confirming this diagnosis, as findings from brushings or biopsies were positive for malignancy in only 14 of 20 patients (70%). Radiologists should be aware of the frequent proximal location of these scirrhous tumors and of the problems of endoscopic diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed1990

Intact stones or fragments? Potential pitfalls in the imaging of patients after biliary extracorporeal shock wave lithotripsy.

Ultrasound is used after extracorporeal shock wave lithotripsy of gallbladder stones to assess fragmentation. In many patients with apparently successful fragmentation, the posttreatment studies show an intraluminal, echogenic focus within the gallbladder, with posterior acoustic shadowing characteristic of an intact stone. Cholesterol gallstones were fragmented in vitro by means of lithotripsy, and the sonographic appearance of the fragmented stones was followed up over time to study factors that might affect the process. After lithotripsy, fragments settled and produced an echogenic focus with posterior shadowing indistinguishable from the appearance of an intact stone. These experimental observations led to the development of a clinical maneuver to overcome the diagnostic pitfalls posed by the reaggregation of stone fragments in situ. This rollover maneuver helps distinguish between intact stones and fragments, and prevents both diagnostic errors in follow-up and unnecessary retreatment.

Cholelithiasis↗
PubMed1989

Atrophic gastritis in pernicious anemia: diagnosis by double-contrast radiography.

A retrospective study was performed to determine whether the areae gastricae pattern in the stomach or other radiologic features could be used on double-contrast upper gastrointestinal examinations to accurately diagnose atrophic gastritis in pernicious anemia. The double-contrast studies from 21 patients with pernicious anemia and 55 age-matched controls were interspersed and reviewed blindly to assess gastric size, mucosal folds, and the areae gastricae pattern in the stomach. The best set of criteria for differentiating the pernicious anemia group from the controls included a fundal diameter of 8 cm or less, absent mucosal folds in the fundus or body, and small (i.e., 1-2 mm in size) or absent areae gastricae. This combination of findings was present in 81% of patients with pernicious anemia but it also was present in 11% of the controls, so that atrophic gastritis in pernicious anemia could not be reliably diagnosed on radiologic criteria. Nevertheless, patients with pernicious anemia invariably had small or absent areae gastricae in the stomach, so that the presence of prominent areae gastricae, particularly in the fundus, may be a useful criterion for excluding this disease.

Anemia, Pernicious↗
PubMed1989

Adult celiac disease and its complications.

Classic radiographic findings described in adult celiac disease--lumen dilatation, flocculation of barium, hypersecretion, thickening of folds--are nonspecific or are secretion related artifacts. The small bowel enema technique and CT make it possible to demonstrate specific diagnostic features of the disease and its complications. This substantially modified approach to the diagnosis of adult celiac disease is presented together with correlative pathology. Examples of the complications of celiac disease--ulcerative jejunoileitis, lymphoma, hyposplenism, carcinoma, and the cavitary lymph node syndrome--are illustrated.

Adult↗
PubMed1989

Pseudomembranous colitis with rectosigmoid sparing on barium studies.

The classic description of pseudomembranous colitis on barium enema studies is that of pancolitis with thickened haustral folds, a shaggy luminal contour, and/or mucosal plaques. However, the authors describe six patients with proved pseudomembranous colitis in whom barium studies (four double-contrast barium enema studies, one single-contrast barium enema study, and one peroral pneumocolon study) demonstrated rectosigmoid sparing with proximal colitis extending from the cecum to the sigmoid colon (three cases) or to the descending colon (three cases). In all six cases, endoscopy revealed a normal rectum or mild, nonspecific proctosigmoiditis without evidence of pseudomembranes in the rectosigmoid colon. Four patients had an atypical clinical presentation with bloody diarrhea (three cases) or minimal mucous diarrhea (one case). Thus, the diagnosis of pseudomembranous colitis may initially be suggested on barium studies in patients who have relative sparing of the rectosigmoid colon with characteristic findings more proximally in the colon.

Barium Sulfate↗
PubMed1989

Bowler-hat sign: a simple principle for differentiating polyps from diverticula.

The bowler-hat sign has been described both with colonic polyps and with diverticula. The authors describe a simple principle for evaluating a bowler-hat sign in order to determine whether it is caused by a polyp or a diverticulum. If the bowler hat points toward the center of the long axis of the bowel, it represents an intraluminal structure (ie, a polyp). If, however, it points away from the center of the long axis of the bowel, it represents an extraluminal structure (ie, a diverticulum). Only if the bowler hat is located in the midline or is directly parallel to the long axis of the bowel is it impossible to classify the abnormality as a polyp or a diverticulum. The value of this principle was confirmed with both a radiographic model and a blinded review of radiographs from 37 cases demonstrating the bowler-hat sign. When a bowler hat is present on a double-contrast barium enema examination, use of this principle provides a simple and objective means of differentiating a polyp from a diverticulum.

Barium Sulfate↗