The radiology corner: Boerhaave's syndrome.
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Adult↗
Biomedical subjects
R N Berk
Publications and source records attributed to R N Berk.
Localized giant pseudopolyposis of the colon.
Localized giant pseudopolyposis is a rare complication in patients with inflammatory diseases of the colon which produces a huge intraluminal polypoid mass. Examples are described in a child with chronic ulcerative colitis in whom the lesion filled the rectum and in an adult with recurrent granulomatous ileocolitis in whom the mass was present in the transverse colon adjacent to a stenotic anastomosis. The clinical presentation, radiologic features and pathologic findings of this unusual sequela to inflammation are reviewed.
Child↗
The radiology corner. The radiographic diagnosis of pica.
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Adolescent↗
Benign hepatic lesions in women taking oral contraceptives.
Four previously unreported cases of benign hepatic cell lesions in young women taking oral contraceptives are described. A brief review of the literature is presented with emphasis on the clinical symptoms, the findings on angiography and radionuclide scan, and the relation of the lesions to oral contraceptives.
Adult↗
Pseudoulcerations of the colon on barium enema examination.
Marginal spiculations and punctate collection of barium may occasionally be identified on barium examination in patients with a normal colon. These may be due either to filling of the crypts of Lieberkuhn with barium or retention of barium in the innominate grooves of the colon. Perhaps both combine to produce the radiographic findings. This normal variant must be carefully distinguished from actual ulcers associated with inflammatory bowel disease in order to avoid making a major error in diagnosis.
Barium Sulfate↗
Immunoglobulin deficiency diseases of the intestine.
Marshak has emphasized the role of the gastrointestinal tract as a major immunologic organ and described the radiologic findings of immunoglobulin deficiency diseases of the small intestine. According to his classification the radiologic findings include multiple nodular defects, edema and increased secretions associated with Giardiasis, a sprue-like pattern, and thickened folds. In this report, the role of the intestine in the immune response is briefly reviewed and several of the radiologic features of immune deficiency diseases and those of benign nodular lymphoid hyperplasia are illustrated.
Adolescent↗
Cholecystokinin cholecystography in the diagnosis of chronic acalculous cholecystitis and biliary dyskinesia. A cirtical appraisal.
Now that the active fragment of the cholecystokinin molecule has been made available for use in clinical pracitce, reports on the value of cholecystokinin cholecystography must be re-evaluated to determine if the procedure is worthwhile in patients with persistent symptoms and a normal conventional oral cholecystogram. Such an analysis discloses that there is no uniform agreement on what consitutes an abnormal examination and raises serious questions concerning the scientific validity of much of the data. It is apparent that there is no immutable evidence to date to indicate that cholecystokinin cholecystography is an accurate technique to determine which patients in this category will benefit from cholecystectomy.
Adolescent↗
The spectrum of radiographic features of aberrant pancreatic rests involving the stomach.
The radiographic features of 20 cases of pathologically confirmed heterotopic pancreatic rests involving the stomach were analyzed. Aberrant pancreatic tissue in the stomach produces a broader spectrum of radiographic findings than had been thought. The mass produced by the aberrant tissue is often larger and more sessile than usually anticipated, and may simulate a mural neoplasm or adenomatous polyp. While most cases occur in the distal antrum or prepyloric area, some occur in the more proximal portion of the antrum. Less than half of the cases in this series included the finding of a small central niche. When a niche was present, it was often large in relation to the mass, and simulated a gastric ulcer or ulcerating neoplasm.
Adolescent↗
Influence of Cholografin and Renografin 76 on platelet function.
Cholografin and Renografin 76 were studied to determine their effects on platelet function. In vitro platelet aggregation was significantly inhibited by at least 3.4 micron/ml Cholografin and 19.5 micron/ml Renografin 76. Patients who received Cholografin for intravenous cholangiography, and Renografin 76 for non-cardiac angiography, had low levels of plasma contrast agent, and hemostasis was clinically unimpaired. Patients who received Renografin 76 for cardiac angiography had inhibition of platelet aggregation at high levels of plasma contrast agent; there was no correlation with prolonged bleeding times, or with bleeding complications. High levels of plasma contrast agent may inhibit platelet aggregation in vitro and in vivo, although this may not be associated with clinically significant bleeding.
Contrast Media↗
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↗
Iotroxamide--a new intravenous cholangiographic agent. Comparison with iodipamide and the effect of bile salts.
The maximum biliary excretion rate of iotroxamide was found to be significantly greater than that of iodipamide in bile-fistula dogs. High bile salt excretion rates had no effect on the rate of biliary excretion of either compound, but the choleresis associated with greater bile salt excretion reduced the biliary concentration of both agents. Both are potent choleretics, stimulating about 23.5 ml of bile per mmole of contrast agent excreted in bile. This obligatory coupling of the contrast agents with water as they are excreted in bile imposes a limit on the maximum concentration that can be achieved in bile. Since iotroxamide is excreted more rapidly in bile than iodipamide for any equimolar plasma concentration, it may be a superior contrast agent for intravenous cholangiography.
Animals↗
Misleading pneumoperitoneum.
Misleading pneumoperitoneum takes one of two forms: true pneymoperitoneum without peritonitis or pneumoperitoneum simulated by adventitious x-ray shadows. In both instances, the roentgenographic appearance of free intraperitoneal air proves to be a specious indication for laparotomy. Twenty-eight per cent of 29 patients with misleading pneumoperitoneum were subjected to operations that, retrospectively, might not seem absolutely necessary. The decisions to operate on patients with pneumoperitoneum without peritonitis were based on the amount of pneumoperitoneum roentgenographically visualized. The instances of pseudopneumoperitoneum had several common features. The diagnosis often was based only on x-ray films of the chest. Compatibility with clinical features was marginal; the radiolucency was often not truly at the apex of the diaphragm. Finally, the x-ray films, interpretation and working conditions frequently were suboptimal.
Adolescent↗
Barium enema examination in acute appendicitis.
The barium enema examination is a safe technique for the prompt and accurate diagnosis of acute appendicitis. Properly performed and correctly interpreted, the examination can serve as a valuable tool for the diagnosis or exclusion of acute appendicitis when this is not possible by clinical and laboratory procedures.
Acute Disease↗
Pharmacology and physiology of the biliary radiographic contrast materials.
(1) Solubilization of Telepaque in the intestine is a limiting factor in the rate of intestinal absorption. Bilopaque and Oragrafin are more water-soluble and appear to be better absorbed than Telepaque. (2) Bile salts in the intestinal lumen increase the solubility of Telepaque. Therefore, a fatty meal administered with the Telepaque is desirable to evacuate bile salts from the gallbladder into the intestine. This is not required for the more water-soluble agents, Biopaque and Oragrafin. (3) The degree of protein binding of the contrast agents can be related to the degree of toxicity. Cholografin is the most highly bound and is the most toxic. (4) Hepatic receptor proteins may specifically bind the biliary contrast agents. This may be the reason that the renal contrast materials are poorly escreted in bile compared to the biliary contrast agents. (5) Telepaque is conjugated in the liver with glucuronide making the compound more soluble in bile. This prevents precipitation of Telepaque in the gallbladder and avoids reabsorpiton from the intestine. (6) The biliary excretion of Telepaque is facilitated by bile salts. Therefore, the administration of a fatty meal with Telepaque not only increases the rate of intestinal absorption of Telepaque but also the rate of biliary excretion. (7) The rate of biliary excretion of both the oral and the intravenous contrast agents appears to be limited by a hepatic transport maximum. Above a certain dose, increased amounts of the contrast agents do not result in more rapid excretion of the agents into bile. Rapid infusion of intravenous contrast agents results in high plasma concentration and greater urinary excretion, without increasing the biliary excretion. It does not appear to be indicated in clinical practice. (8) The biliary concentration of the contrast agents used for intravenous cholangiography is determined by their rate of biliary excretion, the choleretic effect of the contrast agent, and factors that determine the rate of basal bile flow. Fixed coupling of water with the biliary excretion of these contrast agents imposes an inherent limitation on the concentration of the contrast agent in bile. It appears that the biliary concentration of the intravenous contrast materials can be increased by having the patient fast prior to intravenous cholangiography. This decreases the enterohepatic circulation of bile salts and the rate of bile-salt-dependent bile flow. (9) Failure of the gallbladder to visualize after administration of Telepaque when there is adequate biliary excretion may be due to cystic duct obstruction, failure of the inflamed gallbladder mucosa to reabosrb water, or reabsorption or the contrast agent by the diseased gallbladder mucosa. (10) Maximum concentration of Telepaque occurs at 14-19 hr after ingestion. It is at this time that radiographs of the gallbladder should be made. With Bilopaque, peak concentration occurs at 10 hr so radiographs can be made earlier when Bilopaque is used.
Animals↗
Saturation kinetics and choleretic effects of iodoxamate and iodipamide.
The biliary excretion and choleretic effects of iodoxamate (Cholevue) and iodipamide (Cholografin) were compared in unanesthetized dogs with biliary fistulas in order to assess the potential of the two contrast agents for use in intravenous cholangiography. For any equimolar infusion rate, more iodoxamate was secreted in the bile than iodipamide was the same. At the constant basal bile flow maintained in these studies, there was no difference in the maximum biliary concentration of the two compounds. With the presently recommended doses, it is unlikely that iodoxamate will offer a striking improvement over iodipamide for intravenous cholangiography in patients with normal liver function.
Animals↗
The biliary and urinary excretion of iopanoic acid: pharmacokinetics, influence of bile salts, and choleretic effect. An experimental study in bile-fistula dogs.
The biliary and urinary excretion and the choleretic effect of iopanoic acid (Telepaque) were studied in nonanesthetized bile-fistula dogs using a stepwise increase of infusion rates of iopanoic acid and a constant infusion of sodium taurocholate at a rate of either 0.5 or 2.0 mumoles/min./kg. The maximum rate of bile excretion (0.671 mumoles/min./kg) when taurocholate was infused at the lower rate nearly doubled (1.325 mumoles/min./kg) when given at the higher rate. Maximum biliary concentrations of iopanoic acid at both rates of taurocholate infusion (70-77 mumoles/ml) were almost double the maximum concentration previously determined for iodipamide (Cholografin) (42 mumoles/ml).
Animals↗
Predictive factors and mechanism of arrhythmias and myocardial ischaemic changes in elderly patients during barium enema.
The incidence of significant arrhythmias and ST segment changes during barium enema examination (BE) was evaluated by Holter monitoring of 58 unselected patients over the age of 60 years. Forty percent of the group developed new significant arrhythmias of which the most common were frequent and/or multifocal premature ventricular contractions. Seven percent demonstrated ST segment depression. Administration of glucagon did not diminish the incidence of arrhythmias. Predictive factors for ECG abnormalities were advancing age, abnormal pre-BE-ECG, and pre-BE orthostatic hypotension. Analysis of arhythmias and response to phywiologic tension. Analysis of arrhythmias and response to physiologic manoeuvres suggested that the abnormalities were related to increased sympathetic tone which may be intensified by hypovolaemia resulting from routine bowel preparation.
Aged↗
Incidence of arrhythmias and ST-segment changes in elderly patients during barium enema studies.
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Arrhythmias, Cardiac↗