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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 145 records · Page 8Linked to original sources
PubMed1978

Double-contrast artifacts.

With the increasing use of double-contrast technique in radiological evaluation of the gastrointestinal tract, certain artifacts peculiar to this mode of examination need to be identified. These artifacts arise because of: (a) the characteristics of the barium suspensions used for double-contrast studies; (b) the see-through effect obtained on double-contrast studies whereby opacities lying in front of or behind the organ being examined may simulate pathologic lesions; (c) infolding of the mucosa which may simulate pathology; (d) extraneous or foreign material which is frequently detected and must be differentiated from intrinsic disease; (e) certain anatomical structures such as the cardia, pylorus, and retrogastric structures which are seen with unusual clarity and detail and which, in some cases, may simulate pathology. In general, these artifacts may simulate diffuse superficial ulceration, discrete ulceration, or polypoid lesions. Familiarity with the double-contrast technique and an understanding of these artifacts will help to avoid diagnostic errors.

Barium Sulfate↗
PubMed1978

Small-bowel malabsorption and gastrointestinal malignancy.

In addition to lymphoma, there is an increased incidence of gastrointestinal carcinoma in patients with malabsorption due to celiac disease. This is frequently manifested by a loss of response to gluten withdrawal. Four such cases are described: one patient had lymphoma and the other three had cancer of the esophagus, jejunum, and pancreas, respectively. The literature indicates that carcinoma of the esophagus and small bowel is particularly common in patients with celiac disease. These findings suggest that celiac disease should be considered a premalignant condition and that such patients should undergo a regular radiographic survey to detect early cancer.

Aged↗
PubMed1978

Filiform polyposis.

Filiform polyposis presents a characteristic radiographic appearance consisting of long, filamentous filling defects in an otherwise normal colon. It has previously been reported in patients with a prior history of ulcerative colitis and in one patient with granulomatous colitis. The authors document its development in patients with ulcerative and granulomatous colitis. The authors have also seen a solitary filiform polyp in a patient with previously undiagnosed inflammatory bowel disease, and filiform polyps in the stomach in a patient with documented Crohn disease involving the small bowel. It is believed that this represents a nonspecific sequela of diffuse mucosal inflammation; it should not be mistaken for a neoplastic form of polyposis.

Adult↗
PubMed1978

Transverse folds in the human esophagus.

Fine transverse folds can be seen by double contrast technique in the human esophagus which are similar to those seen regularly in the feline esophagus. These folds are transient in nature and possibly represent contraction of the muscularis mucosae. This fold pattern can be seen in patients with gastroesophageal reflux and in those with no symptoms of esophageal disease. The marginal serration should not be mistaken for diffuse ulceration on barium filled views of the esophagus. Distortion of interruption of the normal fold pattern can be seen in patients with superficial ulceration due to reflux esophagitis or other invasive mucosal lesions. Although the pathophysiologic significance of this phenomenon is uncertain, the demonstration and recognition of these folds allows for better definition of mucosal surface abnormalities.

Animals↗
PubMed1978

Double-contrast examination of the postoperative stomach.

Radiological accuracy in evaluating the postoperative stomach conventionally ranges from 20 to 70% (as reported in the literature). Alternatively, a double-contrast examination can be performed using a high-density barium-suspension effervescent agent and glucagon. No intubation is required. In 40 patients who underwent gastric surgery, comparison of radiologic and endoscopic findings indicates that a high quality double-contrast study was very accurate. There were 7 radiologic errors (18%) in the 40 examinations. However, in the examinations assigned the highest confidence level there were no errors, while in those assigned the next highest level there was 1.

Barium Sulfate↗
PubMed1978

Lymphoid follicular pattern: a normal feature of the pediatric colon.

Tiny nodular filling defects up to 2 mm in diameter were seen in 12 of 27 patients under the age of 15 years undergoing double contrast enema. The pattern was particularly common in children under 5 years in whom a good quality double contrast study was obtained. While this pattern has been termed lymphoid hyperplasia, we believe it represents a normal lymphoid follicular pattern in the pediatric colon. The term lymphoid hyperplasia should be reserved for cases in which the lymphoid follicles are greater than 2 mm in diameter; this will usually represent an abnormal condition in response to infection, allergy, or immunologic disorders. The differential diagnosis of the lymphoid follicular pattern and lymphoid hyperplasia is briefly discussed.

Adolescent↗
PubMed1978

Early lesions of Crohn's disease.

In its early stages, Crohn's disease may be manifested as small aphthoid ulcers. Because these ulcers are small and shallow, they are difficult or impossible to demonstrate on conventional barium-filled studies of the gastrointestinal tract. Using double contrast techniques, we have been able to demonstrate these early lesions of Crohn's disease in the colon, small bowel, and stomach. The aphthoid ulcers produce a "bulls-eye" or "target" lesion consisting of a small central collection of barium surrounded by radiolucent halo due to the granulomatous inflammation. The appearance is identical in the colon, small bowel, and stomach. The early lesions may be seen adjacent to or at a distance from a segment of more severe disease. In some patients, only these early lesions are found. The radiologic demonstration of these aphthoid ulcers allows for early diagnosis, facilitates differentiation between ulcerative and granulomatous collitis, and is important for planning appropriate therapy.

Colonic Diseases↗
PubMed1977

Unusual causes of gastrocolic fistula.

1. Three cases of gastrocolic fistula of unusual cause are presented. These include one patient each with carcinoma of the left kidney, gastric lymphoma, and granulomatous colitis. 2. The relationships between the kidneys and gastrointestinal tract are illustrated by a cadaveric cross-section. 3. The wide variety of diseases resulting in gastrocolic fistula is discussed. 4. Careful fluoroscopic and radiographic study may be necessary to detect the site of the fistula and to identify its cause.

Colonic Diseases↗
PubMed1977

Colonic polyp detection: role of roentgenography and colonoscopy.

In order to determine the relative yields of colonoscopic and radiologic examinations of the colon, the following guidelines are suggested: (a) prospective data collection; (b) a standard, effective colon cleansing regimen; (c) colonoscopic and radiologic examiners of comparable expertise; (d) examiners should be unaware of each other's findings; (e) a suitable method for demonstrating false-negative findings and for resolving conflicting findings between the two examinations; and (f) indexing of the study findings as to lesion size, lesion location, quality of colon cleansing, and examiner's level of confidence. The two examinations should be used as complementary diagnostic procedures.

Colon↗
PubMed1977

Air contrast studies of the colon in inflammatory bowel disease.

The purpose of this review is to evaluate the role of double-contrast examination of the colon, in the detection and differential diagnosis of colitis. The emphasis is on correlation with endoscopy, (twelve color endoscopic photographs are included with the corresponding radiographs illustrating the spectrum of abnormalities in ulcerative and granulomatous colitis), differential diagnosis between ulcerative and granulomatous colitis (the double-contrast technique allows for accurate examination of the rectum and careful mapping of the extent and nature of disease in an involved segment. This facilitates the differential diagnosis between ulcerative and granulomatous colitis), and detection of early changes (in ulcerative colitis, the early stage of mucosal edema results in a finely granular mucosa on double-contrast study. In granulomatous colitis, small, shallow, "aphthoid" ulcers are frequently seen as the earliest lesion). The accuracy of the double-contrast technique is assessed by review of series comparing the radiologic and endoscopic findings. This is compared to the accuracy of the conventional enema. Some of the important technical considerations necessary for good double-contrast studies are discussed, as well as some of the potential pitfalls in interpretation.

Barium Sulfate↗
PubMed1976

The double-contrast enema: myths and misconceptions.

The role of the double-contrast enema (DCE) remains contraversial since no controlled comparison between the barium enema (BE) and the DCE has been performed. As a result of our experience with routine use of the DCE, we believe that it is the most sensitive technique for the detection of polypoid, annular, and inflammatory lesions in the colon. There are many commonly held myths and misconceptions regarding the DCE and these are discussed and refuted. The advantages of the DCE over the BE are discussed and illustrated.

Adult↗
PubMed1976

Correlation of endoscopy and double-contrast radiography in the early stages of ulcerative and granulomatous colitis.

Early radiological changes in ulcerative colitis include (a) finely granular mucosa due to hyperemia and edema, (b) mucosal stippling due to adherence of barium to superficial ulcers, and (c) coarsely granular mucosa due to ingrowth of granulation tissue. In granulomatous colitis, early changes include discrete, superficial ulcers, often against a background of normal mucosa, seen best en face. All of these changes can be demonstrated by the double-contrast technique. The radiological and endoscopic findings were in agreement in 95% of the examinations in the authors' series. The importance of the technical aspects of the examination is stressed.

Colitis, Ulcerative↗
PubMed1976

Gastrocolic fistula as a complication of benign gastric ulcer.

The authors present 3 cases which illustrate the wide spectrum of clinical presentations of gastrocolic fistula. These complications include (a) pain, feculent vomiting, and diarrhea; (b) gastrointestinal hemorrhage; and (c) peritonitis. The gastric ulcer is easily detected by a barium meal study although a barium enema may be necessary to show the fistulous communication. The relationship of this condition to steroids and acetylsalicyclic acid is stressed. Two other cases are included to illustrate the development of such a fistula and show the distinguishing features of a gastrocolic fistula due to carcinoma of the colon.

Adult↗
PubMed1976

The left lateral view in the plain-film assessment of abdominal distension.

Since the left lateral position facilitates the entry of air into the rectosigmoid, it has been employed in the plain-film evaluation of patients with abdominal distension. The value of this view is illustrated by examples of patients with (a) colonic ileus due to imipramine hydrochloride (Tofranil) or chlorpromazine, (b) partial mechanical obstruction due to diverticulitis, (c) involvement of the rectum by Hirschsprung's disease, and (d) sequential evaluation of a patient with clindamycin colitis. This simple maneuver is recommended for (a) evaluation of patients with plain-film evidence of low colonic obstruction, (b) problems of differential diagnosis between bowel obstruction and ileus, and (c) evaluation of patients with conditions affecting the rectosigmoid.

Aged↗
PubMed1976

Multiple superficial gastric erosions due to Crohn's disease of the stomach. Radiologic and endoscopic diagnosis.

A case of Crohn's disease involving the stomach and duodenum is presented. The patient had a four-and-a-half year history of ankylosing spondylitis. Double contrast radiography of the stomach and duodenum showed multiple superficial gastric erosions and a duodenal ulcer. There were typical changes of Crohn's disease in the terminal ileum. At endoscopy, numerous superficial erosions were seen in the stomach and duodenum and biopsies of the stomach showed granulomatous inflammation, consistent with Crohn's disease. These lesions are similar to those seen in the colon in the early stages of granulomatous colitis and it is likely that this represents the early stage of Crohn's disease in the stomach. With increasing application of double-contrast radiography and endoscopy, these lesions may be found more frequently.

Adult↗
PubMed1976

Assessment of the accuracy of double contrast gastroduodenal radiology.

The report presents an analysis of routine double contrast gastroduodenal radiology based on our experience with 1500 consecutive examinations. The value of this technique is illustrated by the demonstration of subtle abnormalities such as erosions, linear ulcers, and ulcer scars which are usually not demonstrated by the standard barium study. Two hundred and twenty-five of these patients have also been examined by endoscopy and radiological errors were found in 7%. This represents a marked improvement over the results obtained with the standard method. In the last 128 patients, a confidence level ranging from 3 (certainty) to 1 (uncertain) was assigned to the radiological diagnosis before endoscopy. It was found that the majority of radiological errors occurred in the few studies given the lowest confidence level. These findings indicate that the double contrast study of the stomach and duodenum can be a very accurate examination and that endoscopy can be applied more selectively to patients with inconclusive double contrast studies.

Cicatrix↗