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Biomedical subjects

N Joffe

Publications and source records attributed to N Joffe.

At least 19 recordsLinked to original sources
PubMed1997

Multiplanar helical CT enterography in patients with Crohn's disease.

OBJECTIVE: The purpose of this study was to assess the feasibility and usefulness of helical CT with multiplanar reformations in revealing complications in patients with Crohn's disease. SUBJECTS AND METHODS: Twenty-two patients with Crohn's disease and clinically suspected complications underwent helical CT enterography. The imaging protocol began with the administration of a large volume (1600 ml) of oral contrast material followed by helical scanning with axial and multiplanar two-dimensional coronal projections. Three independent observers assessed the adequacy of bowel opacification and the contribution of two-dimensional coronal projections to the interpretation of axial images. CT enterography was compared with conventional barium studies in 14 patients. Statistical analysis included repeated measures analysis of variance, the Wilcoxon signed-rank test, and the McNemar test. RESULTS: The large oral contrast medium dose was well tolerated and provided optimal bowel opacification in 21 of 22 patients. The addition of multiplanar to conventional axial images did not reveal additional abnormalities; however, multiplanar imaging significantly improved observers' confidence in their interpretation of imaging and in their assessment of the extent of bowel wall thickening (p < .01). Interobserver agreement was 78%. Findings on helical CT were comparable with those on barium studies in nine of 14 patients, superior to those on barium studies in four patients, and inferior in one patient. CONCLUSION: CT enterography is a useful technique for bowel imaging. In patients with complicated Crohn's disease, multiplanar imaging improves confidence in assessing the presence and extent of disease. CT enterography is complementary and often superior to conventional barium studies.

Adult↗
PubMed1981

Primary carcinoma of the gallbladder associated with chronic inflammatory bowel disease.

Patients with chronic inflammatory bowel disease have an increased risk of developing carcinoma of the bile ducts. This risk is highest in those with a long history of colitis and total involvement of the colon. The majority of these biliary tract cancers involve the extrahepatic or intrahepatic bile ducts. Occasionally, however, the gallbladder is the site of origin of the tumour. We report three cases of primary carcinoma of the gallbladder complicating chronic inflammatory bowel disease. In two, there was universal chronic ulcerative colitis and in one, Crohn's ileocolitis.

Adenocarcinoma↗
PubMed1981

Penetration into spleen by benign gastric ulcers.

Penetration of the wall of the stomach by a benign ulcer may result in free perforation into the greater or lesser peritoneal cavities. A "confined perforation" occurs when a penetrating ulcer is walled-off by an adjacent structure or organ. The commonest sites of secondary involvement are the pancreas, gastrohepatic omentum, liver, biliary tract, colon and mesocolon. Penetration into the spleen by a benign gastric ulcer is relatively rare and the literature contains few reports of this complication. We report three cases of penetration of the spleen by benign gastric ulcers. In one patient, splenic penetration was predicted pre-operatively by the recognition of splenic tissue in endoscopic biopsy material.

Female↗
PubMed1981

Diffuse mucosal granularity in double-contrast studies of Crohn's disease of the colon.

The radiographic manifestations of idiopathic ulcerative colitis and Crohn's disease of the colon have been extensively reviewed and are well known. The increasing use of primary double-contrast barium enemas in patients with inflammatory bowel disease has led to enthusiastic reports concerning the differentiation of ulcerative colitis and Crohn's disease. Typically, in ulcerative colitis there is a continuous, diffuse granular mucosal pattern, with or without superadded ulceration; in contrast, Crohn's colitis is characterised by discrete ulcers with intervening normal mucosa. In this paper the occurrence of continuous diffuse mucosal granularity in Crohn's disease of the colon is described. Four selected cases are used as illustrative examples to emphasise the non-specific nature of this particular finding. Caution must be exercised in attributing specific mucosal patterns to the various forms of infectious and non-infectious colitis.

Adult↗
PubMed1981

Crohn's disease in the elderly.

To determine the features of Crohn's disease in elderly patients we reviewed the charts, roentgenograms and pathology of patients with Crohn's disease admitted to our hospital from 1966 through 1979. Thirty-three patients (5.2% of the total) had the onset of symptoms and diagnosis made after age 60, including 18 (55%) with ileitis alone, 11 with colitis and four with ileocolitis. Six patients were seen, four with colitis and two with ileocolitis, with acute toxicity requiring early surgery. The clinical, radiographic and histologic characteristics of the disorder in older patients were otherwise similar to those described in younger patients. Differentiation of ischemic bowel disease and diverticulitis from Crohn's disease in such patients was difficult without reliance on histologic as well as clinical and roentgenographic features. Fifty-eight per cent of these older patients eventually required surgery, including 10 of 11 (91%) with colitis, two fo four with ileocolitis and seven of 18 (39%) with ileitis. The cumulative clinical recurrence rate, limited to patients with ileal disease, was 21% at nine years and 37% at 15 years.

Aged↗
PubMed1980

Radiographic appearances and course of discrete mucosal ulcers in Crohn's disease of the colon.

Although the radiographic manifestations of Crohn's disease of the colon have been extensively reviewed, few reports specifically illustrate the evolution of discrete mucosal ulcers in this disease. There is, moreover, some controversy concerning the nature and significance of small or so-called aphthous ulcers in the pathogenesis of Crohn's colitis. In this study, results from sequential primary double-contrast barium enemas performed over a 5-year period in 21 patients with proven Crohn's colitis were reviewed. A localized segment of colon showing discrete mucosal ulcers was selected for analysis and comparison in serial examinations. The radiographic appearances and course of these discrete mucosal ulcers are described and illustrated.

Barium Sulfate↗
PubMed1980

Edema of the papilla of Vater simulating retained common duct stone.

A prominent or edematous papilla of Vater may prodce a rounded filling defect in the duodenum. During T tube or operative cholangiography, this may simulate a calculus impacted in the distal or intramural portion of the common bile duct. This communication reports such an occurrence. Recognition of this potential cause for a false positive cholangiogram should prevent some instances of unnecessary instrumentation of the common bile duct.

Aged↗
PubMed1979

Right-angled narrowing of the distal oesophagus secondary to carcinoma of the tail of the pancreas.

Dysphagia due to secondary involvement of the oesophagus by pancreatic carcinoma is relatively rare. Occasionally, the oesophagus may be involved by direct extension of a carcinoma of the body and/or tail of the pancreas or metastatic lymphadenopathy in the posterior mediastinum. Although the literature contains a few case reports in which barium studies revealed displacement or obstruction of the distal oesophagus, a benign-appearing, smooth, tapered narrowing of the distal oesophagus with a fixed, right-angled configuration is a radiological finding which has not been previously emphasised. In the author's experience, this abnormality may be a helpful radiological clue to the diagnosis of carcinoma of the tail of the pancreas. The clinical, radiological and pathological findings in four patients with dysphagia and a right-angled narrowing of the distal oesophagus secondary to carcinoma of the tail of the pancreas are described and illustrated; the radiological differential diagnosis is briefly discussed.

Deglutition Disorders↗
PubMed1978

Focal granulomatous (Crohn's) colitis: radiologic-pathologic correlation.

In patients with Crohn's disease, early or localized lesions of the colon, termed 'focal granulomatous colitis', may give rise to small and often relatively inconspicuous nodular or tumor-like contour defects in conventional barium enema studies. This radiologic sign, first illustrated by Ettinger [7], has received scant attention in the literature. The present communication is intended to re-emphasize the radiologic appearances of focal granulomatous (Crohn's) colitis in conventional barium enema examinations, provide pathologic correlation, and illustrate by selected case reports the clinical significance of recognizing this particular radiologic abnormality.

Adult↗
PubMed1978

Anastomotic dehiscence after low anterior resection of the rectum.

Thirty-two patients who had anastomoses to the extraperitoneal rectum underwent radiographic contrast studies about two weeks after operation in order to determine the incidence of anastomotic dehiscence. No extravasation occurred in the sixteen anastomoses in which the middle hemorrhoidal arteries were intact, but partial disruption occurred in four of seventeen (24%) anastomoses in which the middle hemorrhoidal arteries were sacrificed. Since not all patients with anastomotic dehiscence after low anterior resection are symptomatic, the incidence of anastomotic breakdown will be under-estimated unless x-ray studies are performed. More data are required for a better understanding of the technical features of operation which will reduce the incidence of leakage from anastomoses to the extraperitoneal rectum.

Adult↗
PubMed1978

Osteoblastic bone metastases secondary to adenocarcinoma of the pancreas.

The incidence of bone metastases secondary to adenocarcinoma of the exocrine pancreas is unknown since radiological studies of the bones during life, routine bone scintigrams or extensive examination of the skeleton at autopsy is rarely undertaken in the absence of specific clinical indications. Symptom-producing bone metastases are relatively uncommon; a review of the literature suggests that the vast majority are osteolytic in nature with only a few isolated case reports of purely blastic deposits. In the authors' experience osteoblastic bone metastases are commoner than is generally recognised. Of 12 patients with symptom-producing bone deposits secondary to adenocarcinoma of the pancreas, five (41.6%) were purely blastic in nature. The clinical, radiological and pathological findings in these five cases are reported in order to emphasise that the pancreas is a potential source of purely blastic bone metastases and should be considered as a possible primary site in patients who present initially with osteoblastic bone deposits of unknown origin.

Adenocarcinoma↗
PubMed1978

Isolated mesenteric desmoids (mesenteric fibromatosis).

The so-called desmoid tumour is an important member of a group of conditions termed "the fibromatoses" which are characterised by an infiltrating fibroblastic proliferation without features of an inflammatory response. While desmoids most frequently arise in the anterior abdominal wall, they may also be extra-abdominal or intra-abdominal in location. Mesenteric desmoids are relatively rare. They may occur in association with Gardner's syndrome, especially following colectomy, or as an isolated abnormality in otherwise normal patients. In the present paper the authors describe the clinical, radiological and pathological findings in two patients with isolated mesenteric desmoids. The radiological differential diagnosis is also briefly discussed.

Adult↗
PubMed1978

Symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma.

Gastrointestinal metastases secondary to bronchogenic carcinoma are relatively uncommon and most are found incidentally at autopsy examination in patients with advanced or widely disseminated lung cancer. Occasionally gastrointestinal metastases occurr relatively early in the course of the disease and give rise to a variety of clinical symptoms and radiological abnormalities. Recognition of these abnormalities is important in order that appropriate palliative therapy may be undertaken. The clinical. radiological and pathological findings in 12 patients with symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma were reviewed. Clinical symptoms varied according to the site of metastatic involvement and included dysphagia, epigastric pain, nausea, vomiting, gastrointestinal bleeding, anaemia and signs of intestinal obstruction or perforation. The sites of metastatic involvement were: oesphagogastric junction (2 cases); stomach (2 cases); duodenum (1 case): jejunum (3 cases); ileum (2 cases), colon (2 cases). The radiological findings are discussed and illustrated.

Aged↗