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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1986

Acute alcoholic esophagitis.

We report two patients with acute, transient esophagitis following alcoholic binges. Double-contrast esophagrams of both patients revealed erosive esophagitis with multiple superficial ulcers in the mid and distal esophagus. While acute alcoholic esophagitis may produce clinical and radiographic findings that are indistinguishable from other more common types of esophagitis, this diagnosis is supported by the patients' recent drinking history.

Adult↗
PubMed1985

Candida esophagitis: accuracy of radiographic diagnosis.

Candida esophagitis was diagnosed radiographically in 106 patients. Endoscopy was performed in 32 of these patients, and the diagnosis was confirmed in 27. The diagnosis was missed radiographically in seven other cases proved endoscopically. Thus, Candida esophagitis was diagnosed on esophagography in 80% (27/34) of proved cases, with five false-positive examinations. Single-contrast technique was employed in nine cases with a sensitivity of 55%, and double-contrast technique was used in 25 cases with a sensitivity of 88%. With double-contrast technique, esophagography appears to be a more accurate method for diagnosing Candida esophagitis than has been suggested in the literature.

Adult↗
PubMed1985

Early gastric cancer. Recent experience.

Early gastric cancer (EGC) is defined as carcinoma in which malignant invasion is limited to the mucosa or submucosa. Records of pathologic examinations from the Hospital of the University of Pennsylvania show that EGC comprised 6% of all gastric carcinomas diagnosed between 1977 and 1983 (7/118 cases) compared with 8.2% of gastric carcinomas diagnosed between 1965 and 1977 (12/147 cases). Double contrast radiographic techniques and fiberoptic endoscopy became widely available at our institution in 1976. Thus, the application of these techniques to symptomatic patients has not improved our ability to diagnose EGC. In contrast, the incidence of EGC in Japan has risen from 5% to 35% with the widespread use of these diagnostic techniques. This discrepancy can be attributed to mass screening of asymptomatic patients in Japan because of the unusually high prevalence of gastric carcinoma in that country. American radiologists and endoscopists should therefore recognize that they are unlikely to experience a significant increase in the detection of EGC as long as these examinations are performed predominantly on symptomatic patients.

Adenocarcinoma↗
PubMed1985

Radiography of the small bowel in patients with gynecologic malignancies.

The records and radiographs of 284 patients with gynecologic malignancy were reviewed to determine the incidence and nature of small-bowel abnormalities. Seventeen percent of the patients had small-bowel studies. Twenty-four percent of patients with ovarian cancer had radiologic examination of the small bowel, and in almost all cases the abnormalities were due to metastatic disease. In patients with cervical cancer, small-bowel radiography was performed in 14% of patients, and in most cases the abnormalities were due to radiation damage. Small-bowel obstruction was found in 20 patients. In the ovarian-cancer group, all obstructions were due to metastatic disease, whereas in the cervical cancer group, obstruction was due to metastases, radiation, or adhesions. The site of obstruction was a useful differential point, since all obstructions due to radiation were in the ileum, whereas 58% of obstructions due to metastases were in the duodenum or jejunum. The radiologic studies interpreted in light of the clinical circumstances were highly accurate in determining the location and nature of small-bowel complications in these patients.

Barium Sulfate↗
PubMed1984

Adenocarcinoma of the esophagus: relationship to Barrett mucosa.

Primary adenocarcinoma of the esophagus is thought to be a rare lesion. However, pathologic records at our institution from 1979 to 1982 show that adenocarcinoma accounted for 17 of 89 (19%) of all primary malignant tumors in the esophagus. All 17 cases arose in Barrett mucosa. In eight cases, there was surgically proved involvement of the gastric cardia or fundus. In six of these cases, there was evidence of esophageal dysplasia and/or carcinoma in situ adjacent to or remote from the proximal margin of the tumor. The pathologic findings therefore strongly suggest an esophageal origin of these lesions with subsequent spread into the stomach. Clinical and radiographic findings at presentation were indistinguishable from those of squamous cell carcinoma. However, 10 patients had long-standing reflux symptoms, and Barrett esophagus had presumably been present for some time prior to the development of malignancy. Since adenocarcinoma evolves through a sequence of dysplasia and carcinoma in situ in pre-existing Barrett epithelium, the best hope for improving survival may be periodic endoscopic surveillance of asymptomatic individuals who have this condition.

Adenocarcinoma↗
PubMed1984

Mucosal surface patterns of the duodenal bulb. Subject review.

While the duodenal mucosa usually exhibits a smooth, featureless surface on the double-contrast barium examination, on occasion a fine mucosal pattern can be demonstrated. Several pathological processes, including erosive duodenitis, Crohn disease, and celiac disease, may produce subtle alterations in the normal surface pattern. Various normal and abnormal mucosal patterns are illustrated.

Barium Sulfate↗
PubMed1984

The tube esophagram: a technique for obtaining a detailed double-contrast examination of the esophagus.

Although double-contrast esophagography is capable of delineating fine surface morphologic detail in the esophagus, it is not possible to obtain an optimal examination on all patients. Tube esophagography is a complementary technique that can provide a more detailed double-contrast examination of the esophagus. This procedure was performed on 45 patients in whom the routine double-contrast study was inconclusive. The tube esophagram contributed significantly to the radiologic evaluation in 33 cases, providing additional information in 23 and actually altering the final radiologic diagnosis in 10. The tube esophagram was particularly useful in depicting the distal esophagus when the initial double-contrast study was suboptimal due to inadequate distension and/or barium pooling that obscured mucosal detail in this region. The tube esophagram is a valuable adjunctive procedure that can lead to a more definitive radiologic diagnosis when the routine double-contrast examination is inconclusive.

Air↗
PubMed1984

Response of gastric lymphoma to chemotherapy: radiographic appearance.

Although the initial radiographic appearance of gastric lymphoma is well described, there are few descriptions of the evolution of these gastric lesions after chemotherapy. Double-contrast upper gastrointestinal examinations were performed in four patients with gastric lymphoma before and after chemotherapy. The following responses were observed: (1) complete resolution without scarring, (2) resolution to a benign-appearing ulcer, (3) ulceration within a plaque associated with a decrease in tumor mass, and (4) ulceration, perforation, and healing to a benign-appearing ulcer scar. Ulceration of gastric lesions after chemotherapy, observed in two cases, was associated with occult gastrointestinal bleeding. These tumors may regress in response to chemotherapy, leaving a benign-appearing ulcer or ulcer scar as the only radiographic evidence of a lymphomatous gastric lesion.

Adult↗
PubMed1984

Small-bowel enema in the diagnosis of adhesive obstructions.

The small-bowel enema was evaluated in 60 patients in whom a final diagnosis of adhesive obstruction was made by surgery or on the basis of clinical findings. Distinctive radiographic and clinical features were found with single versus multiple bands. While 72% of 32 single-band obstructions were graded as severe, this grading was given to only 34% of 18 obstructions by multiple bands. Extensive adhesions were demonstrated in 10 patients and presented varied radiographic features. The radiographic diagnosis of adhesive obstruction was found to be correct in 36 (87.8%) of 41 patients in whom a surgical diagnosis could subsequently be made. However, an incorrect radiologic diagnosis of obstruction by metastases was made in five patients. They form the basis for a discussion of the differential diagnosis.

Adolescent↗
PubMed1984

Double-contrast examination. Part I: Oesophagus, stomach and duodenum.

The double-contrast upper gastrointestinal radiograph is an excellent modality for detailed evaluation of the oesophagus, stomach and duodenum. Through its use subtle inflammatory and neoplastic lesions can be diagnosed. It also provides a more detailed look at gross pathology than can be achieved with conventional studies alone. Despite the benefits of double-contrast the single-contrast phase of the study remains important and it is included in all cases. This combined study remains an important modality in the diagnosis of upper gastrointestinal disease.

Choristoma↗
PubMed1983

Drug-induced esophagitis detected by double-contrast radiography.

Patients with esophageal symptoms following drug ingestion underwent double-contrast upper gastrointestinal studies, and radiographic findings are described. Superficial esophageal ulceration and subtle mucosal abnormalities, which have not been seen on single-contrast radiographs, were confirmed on double-contrast radiographs. Erosions or ulcers usually occur in the region of the aortic arch and occasionally lower in the esophagus. Repeat esophagrams after withdrawal of the medication indicate resolution of the symptoms.

Adult↗
PubMed1983

Barrett esophagus: reticular pattern of the mucosa.

Barrett esophagus is an acquired condition with progressive columnar metaplasia of the esophagus due to chronic reflux esophagitis. The premalignant nature of this entity is well recognized. However, radiologic diagnosis has been limited by the nonspecificity of findings associated with the condition. We recently reviewed 29 cases of pathologically proved Barrett esophagus. Radiologic examinations revealed hiatal hernias, gastroesophageal reflux, esophagitis, and strictures. None of these findings are diagnostic of Barrett esophagus. In seven cases, however, double-contrast radiography also revealed a delicate reticular pattern in the esophagus. In all but one case, there was an adjacent stricture, and this reticular appearance extended distally a short but variable distance from the stricture. To our knowledge, this unusual reticular pattern has not been described previously, and it represents a valuable radiologic sign of Barrett esophagus. The etiology of this finding is uncertain, but correlation with the gross surgical specimen in one case suggests that it results specifically from areas of "villous" metaplasia in Barrett epithelium. This delicate reticular pattern appears to be a specific radiologic criterion for the diagnosis of Barrett esophagus.

Adult↗
PubMed1983

Carcinoma of the gastric cardia in young people.

Carcinoma of the gastric cardia is usually considered a disease of middle-aged or elderly patients and is rarely suspected in young individuals. However, six cases are reported in patients under 45 years of age. The youngest was 26. A review of patient records revealed no obvious predisposing factor to account for the development of cancer at an early age. In four cases, double-contrast upper gastrointestinal examinations revealed a polypoid mass at the cardia. In two cases, however, the true origin of a tumor arising at the cardia was only recognized by obliteration of the normal anatomic landmarks at the cardia associated with irregular areas of ulceration. In all six cases, the tumor extended into the distal esophagus. Five patients presented with dysphagia. Careful radiographic evaluation of the cardia and fundus is therefore essential to rule out an underlying carcinoma of the cardia in all patients with dysphagia, regardless of age.

Adenocarcinoma↗