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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 91 records · Page 5Linked 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

Gastric ulceration caused by heater probe coagulation.

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.

Arteriovenous Malformations↗
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

Distal esophageal ballooning following Heller myotomy.

Eccentric ballooning of the distal esophagus was observed radiographically in 11 of 23 patients (48%) who underwent Heller myotomy for achalasia. While, to the authors' knowledge, ballooning at the site of myotomy incision has not been described previously in the radiologic literature, it should be recognized as a normal and frequent postoperative finding. Radiologists should be aware of this finding so that it is not mistaken for postoperative abnormalities following esophagomyotomy or an epiphrenic diverticulum.

Adult↗
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

Radiation therapy of esophageal carcinoma: correlation of clinical and radiographic findings.

Seventeen patients with esophageal carcinoma treated by radiation therapy (RT) at our hospital between 1981 and 1984 had initial diagnostic esophagrams and 1 or more repeat esophagrams after completing RT. Total regression of the tumor was observed radiographically in 10 patients (59%) with a normal esophagus (24%) or benign-appearing residual stricture (35%) at the site of the previous lesion. Partial regression was observed in 4 patients, and progression of the tumor in 3. No correlation was found between the size, stage, or morphology of the lesion and its response to therapy. Although local recurrences were relatively uncommon, patient survival was often limited by the development of distant metastases. Fourteen of 15 patients with clinical follow-up initially had significant relief from dysphagia as the tumor regressed. However, 9 of those patients had recurrent or increased dysphagia over a subsequent 3-9-month period. Exacerbation of symptoms did not necessarily indicate recurrent carcinoma; it also resulted from benign radiation strictures, opportunistic esophagitis, or other complications of RT detected on esophagography.

Aged↗
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

Solitary rectal ulcer syndrome: a radiologic diagnosis?

The solitary rectal ulcer syndrome (SRUS) is an uncommon condition in which a solitary area of discrete ulceration is typically found on the anterior wall of the rectum. Between 1981 and 1983, we collected 8 pathologically proven cases of SRUS in which barium enema examinations had been performed (7 double-contrast, 1 single-contrast). Seven patients had rectal bleeding. On the original x-ray report, 4 cases were thought to be normal, but the pathologic tissue had been removed endoscopically in 2 of these cases prior to the radiologic study. The other 4 cases were thought to be abnormal, although the specific diagnosis of SRUS was not suggested in any case. In a blinded rereading of these 8 cases randomly interspersed with 29 other non-SRUS cases, however, the films were interpreted in light of recent radiologic experience with this condition. The same 4 cases were still thought to be normal. In the remaining 4 cases, barium enemas revealed thickened, edematous valves of Houston (3 cases) and a submucosal mass adjacent to the anal verge (1 case). The diagnosis of SRUS was suggested in all 4 cases with only 1 false-positive diagnosis due to a rectal stricture in a patient with endometriosis. Although barium enemas may be normal in patients with SRUS, the presence of thickened, edematous valves of Houston, particularly in a young patient with rectal bleeding, should suggest this condition.

Adult↗
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

Serpiginous gastric erosions caused by aspirin and other nonsteroidal antiinflammatory drugs.

Erosive gastritis is a common disease, but no etiologic significance has been attributed to the size or shape of these gastric erosions. However, in 12 cases of erosive gastritis caused by aspirin (nine) and other nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin, two; naproxen, one) double-contrast upper gastrointestinal studies revealed incomplete linear and/or serpiginous erosions in the stomach. In nine cases, these distinctive erosions were clustered focally in the body of the stomach, on or near the greater curvature. All but one patient were symptomatic (epigastric pain, eight; upper gastrointestinal bleeding, two; nausea and vomiting, one), and marked clinical improvement occurred within several days after withdrawal of the offending agent. This experience suggests that incomplete linear or serpiginous erosions, particularly along the greater curvature of the stomach, should be strongly suggestive of aspirin- or other NSAID-induced gastritis. If recent ingestion of these drugs is confirmed, withdrawal of the offending agent should lead to a rapid clinical response in these patients.

Anti-Inflammatory Agents↗
PubMed1986

Early esophageal cancer.

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.

Adenocarcinoma↗