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Biomedical subjects

S E Rubesin

Publications and source records attributed to S E Rubesin.

At least 19 recordsLinked to original sources
PubMed2002

Radiographically diagnosed antral gastritis: findings in patients with and without Helicobacter pylori infection.

The purpose of this study was to characterize the radiographic findings of antral gastritis and to determine whether there are differences in the appearance of antral gastritis in patients with and without Helicobacter pylori infection. A search of radiology, endoscopy and pathology files revealed 90 patients with antral gastritis on double contrast upper gastrointestinal tract studies who had endoscopy with testing for H. pylori. The barium studies were evaluated to further characterize the findings of antral gastritis without knowledge of the H. pylori status of the patients or of the endoscopy or pathology findings. The radiographic findings of antral gastritis included thickened folds in 67 patients (74%), polypoid antral gastritis (a subset of patients with thickened folds) in 6 (9%), antral erosions in 21 (23%), enlarged areae gastricae in 14 (16%), crenulation of the lesser curvature in 4 (4%), mucosal nodularity in 2 (2%), a hypertrophied antral-pyloric fold in 2 (2%) and antral striae in 1 (1%). 43 patients (48%) with antral gastritis were H. pylori positive and 47 patients (52%) were H. pylori negative. Thickened folds were detected in 39 H. pylori-positive patients (91%) with antral gastritis vs 28 H. pylori-negative patients (60%) (p<0.001); polypoid gastritis in 6 H. pylori-positive patients (14%) vs 0 H. pylori-negative patients (p<0.05); enlarged areae gastricae in 14 H. pylori-positive patients (33%) vs 0 H. pylori-negative patients (p<0.0001); and antral erosions in 2 H. pylori-positive patients (5%) vs 19 H. pylori-negative patients (40%) (p<0.0001). Our experience suggests that antral gastritis caused by H. pylori infection is associated with characteristic features on double contrast studies (including thickened folds, polypoid gastritis and enlarged areae gastricae) and that this condition is rarely associated with antral erosions. Thus, radiologists can often suggest whether the patient's gastritis is caused by H. pylori on the basis of radiographic findings.

Adult↗
PubMed2001

Radiologic and endoscopic diagnosis of Crohn's disease.

This article reviews the radiologic and endoscopic diagnosis of Crohn's disease. Radiographic and endoscopic findings of Crohn's disease are discussed; a practical approach to the selection of radiologic modalities is presented; and the role of endoscopy in diagnosis and treatment is explained.

Abscess↗
PubMed2001

Fecal impaction: a cause of isolated small bowel dilatation on abdominal radiographs.

OBJECTIVE: The purpose of this study was to assess the frequency of isolated small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. METHODS: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed to determine the distribution of fecal impaction and the degree and extent of small bowel dilatation. In 16 cases, medical records were reviewed to determine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treatment of the impaction. RESULTS: All 16 patients with available medical records had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impaction (five) that involved the cecum, and the remaining four (22%) had a left-sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolution of small bowel dilatation after treatment of the underlying impaction. CONCLUSION: Fecal impaction should be considered in the differential diagnosis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with resolution of the small bowel dilatation on follow-up radiographs.

Adult↗
PubMed2001

Short-segment Barrett's esophagus: findings on double-contrast esophagography in 20 patients.

OBJECTIVE: The purpose of this study was to determine the findings of short-segment Barrett's esophagus on double-contrast esophagography. MATERIALS AND METHODS: A review of pathology and endoscopy data revealed 142 patients with short-segment Barrett's esophagus, which was defined as columnar epithelium in the distal esophagus extending 3 cm or less above the gastroesophageal junction at endoscopy with histopathologic confirmation of intestinal metaplasia. Twenty of these patients underwent double-contrast esophagography. These 20 patients comprised our study group. The original radiology reports and images were reviewed to determine the findings on double-contrast esophagography. Medical records were also reviewed to determine the clinical findings and treatment. RESULTS: Double-contrast esophagrams revealed hiatal hernias in 18 patients (90%), gastroesophageal reflux in 16 (80%), reflux esophagitis in seven (35%), peptic scarring or strictures in 11 (55%), and a reticular mucosal pattern in none. A total of 14 patients (70%) had morphologic findings of reflux disease with esophagitis alone (three patients), peptic scarring or strictures alone (seven patients), or both (four patients), but the remaining six (30%) had hiatal hernias or gastroesophageal reflux as the only radiographic finding. CONCLUSION: Double-contrast esophagography revealed morphologic findings of reflux disease with esophagitis, peptic scarring or strictures, or both in 70% of patients with short-segment Barrett's esophagus. Thus, the absence of esophagitis or peptic scarring or strictures on double-contrast esophagography does not exclude the possibility of short-segment Barrett's esophagus.

Adult↗
PubMed2001

Congenital esophageal stenosis in adults: clinical and radiographic findings in seven patients.

OBJECTIVE: The purpose of this study was to determine the clinical and radiographic findings in seven adults with congenital esophageal stenosis. CONCLUSION: In young or middle-aged individuals, particularly men with long-standing dysphagia, an upper or mid esophageal stricture with multiple ringlike constrictions is a characteristic appearance of congenital esophageal stenosis on double-contrast esophagography.

Adult↗
PubMed2001

Visualization of areae gastricae on double-contrast upper gastrointestinal radiography: relationship to age of patients.

OBJECTIVE: The purpose of this study was to determine whether the frequency of visualization of areae gastricae on double-contrast upper gastrointestinal tract examinations is related to a patient's age. MATERIALS AND METHODS: A total of 141 double-contrast upper gastrointestinal tract examinations with normal findings were reviewed for the presence or absence of areae gastricae on double-contrast images of the stomach. All images were evaluated by two radiologists who were blinded to the age of the patients. The data were then analyzed to determine if the frequency of visualization of areae gastricae on double-contrast studies was significantly related to the age of patients. RESULTS: The frequency of visualization of areae gastricae increased significantly with increasing age (p = 0.008). The youngest age group (20--29 years old) exhibited areae gastricae in only four (19%) of 21 cases, whereas the oldest age group (> or = 70 years old) exhibited areae gastricae in 19 (76%) of 25 cases. On average, the rate of visualization of areae gastricae on double-contrast studies increased by 9% per decade. CONCLUSION: Our data show that the frequency of visualization of areae gastricae on double-contrast upper gastrointestinal tract examinations increases significantly with increasing patient age. It is important for radiologists to be aware of the effect of aging on the delineation of areae gastricae on double-contrast studies.

Adult↗
PubMed2001

Lymphoid hyperplasia of the stomach: radiographic findings in five adult patients.

OBJECTIVE: The purpose of our study was to report the radiographic findings of biopsy-proven lymphoid hyperplasia of the stomach in five adult patients. CONCLUSION: Lymphoid hyperplasia of the stomach is characterized by distinctive findings on double-contrast upper gastrointestinal tract barium examinations; all five patients had innumerable tiny (1--3 mm in diameter) round frequently umbilicated nodules that carpeted the mucosa of the gastric antrum or antrum and body. Three of these five patients had associated Helicobacter pylori gastritis. The diagnosis of gastric lymphoid hyperplasia, therefore, can be suggested on the basis of the radiographic findings.

Adult↗
PubMed2001

Killian-Jamieson diverticula: radiographic findings in 16 patients.

OBJECTIVE: The purpose of this study was to reassess the findings of Killian-Jamieson diverticula (i.e., proximal lateral cervical diverticula) on pharyngoesophagograms and to compare the prevalence, clinical findings, and radiographic findings of Killian-Jamieson diverticula with those of Zenker's diverticulum. MATERIALS AND METHODS: A computerized search of radiology files revealed 16 patients with Killian-Jamieson diverticula and 26 patients with a Zenker's diverticulum. The double-contrast pharyngoesophagograms and medical records were reviewed retrospectively. RESULTS: Only three (19%) of 16 patients with Killian-Jamieson diverticula had symptoms attributable to the diverticula (suprasternal dysphagia in two and cough in one), and none had aspiration pneumonia. In contrast, 16 (62%) of 26 patients with a Zenker's diverticulum had suprasternal dysphagia and three patients (12%) had aspiration pneumonia. Twenty Killian-Jamieson diverticula were detected on pharyngoesophagograms in 16 patients, including 12 (75%) with unilateral left-sided diverticula and four (25%) with bilateral diverticula. The Killian-Jamieson diverticula had an average maximal dimension of 1.4 cm. Zenker's diverticulum was nearly four times as common as Killian-Jamieson diverticula and had an average maximal dimension of 2.5 cm. Three patients (11%) with a Zenker's diverticulum had reflux of barium from the diverticula into the hypopharynx with overflow aspiration. Finally, gastroesophageal reflux was detected in nearly twice as many patients with a Zenker's diverticulum as with Killian-Jamieson diverticula. CONCLUSION: Killian-Jamieson diverticula are less common and smaller than Zenker's diverticulum. Killian-Jamieson diverticula are less likely to cause symptoms and are less likely to be associated with overflow aspiration or gastroesophageal reflux than is Zenker's diverticulum.

Adult↗
PubMed2001

Radiographic findings and complications after surgical or endoscopic repair of Zenker's diverticulum in 16 patients.

OBJECTIVE: The purpose of our study was to reassess the radiographic findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum. MATERIALS AND METHODS: Sixteen patients who underwent various procedures for repair of Zenker's diverticulum (diverticulectomy and cricopharyngeal myotomy in [n = 8], diverticulopexy and cricopharyngeal myotomy [n = 4], endoscopic stapling diverticulotomy [n = 3], and cricopharyngeal myotomy alone [n = 1]) had radiographic studies with water-soluble contrast material, barium, or both during the early postoperative period (n = 7), late postoperative period (n = 4), or both (n = 5). The radiologic reports and images were reviewed to determine the postoperative findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum. RESULTS: Radiographic studies revealed leaks during the early postoperative period in three (27%) of 11 patients after surgical repair of Zenker's diverticulum and in zero of three patients after endoscopic diverticulotomy. Pharyngeal dysfunction (pharyngeal paresis, decreased epiglottic tilt, laryngeal penetration, or tracheobronchial aspiration) was detected in seven (54%) of 13 patients after surgery and in one (33%) of three patients after endoscopic diverticulotomy; five of these eight patients had follow-up barium studies during the late postoperative period, and all five showed marked improvement in pharyngeal function. An extrinsic cricopharyngeal impression was detected in six (38%) of these 16 patients, a remnant diverticulum in four (25%), and mucosal beaking in three (19%). A suspended or inverted diverticulum was detected in one of the four patients who underwent surgical diverticulopexy. CONCLUSION: Radiologists should be aware of the various postoperative findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum so that appropriate interventions can be taken in patients with this condition.

Adult↗
PubMed2000

Double-contrast barium enema examination technique.

This review article presents the principles for performing a safe, comfortable, and accurate double-contrast barium enema examination. The procedure is a flexible examination in which the fluoroscopist interacts with the patient, the controls of the fluoroscope, and the image on the television monitor. During a double-contrast examination, images of the colon are created by manipulating the patient, the barium pool, and the amount of air insufflated into the rectum. Fluoroscopy is essential for guiding the radiologist to obtain spot images with adequate technical factors. The fluoroscopist analyzes the luminal contour, the barium-coated mucosal surface en face, and the barium pool to detect abnormalities in the colon. With careful technique, a high-quality examination can be performed in most patients.

Barium Sulfate↗
PubMed2000

Diagnosis of colorectal neoplasms at double-contrast barium enema examination.

The double-contrast barium enema examination has been recognized as an option for colorectal cancer screening in Americans with average risk who are greater than 50 years of age. The purpose of this article is to review the principles for diagnosing colorectal neoplasms on double-contrast images and the spectrum of findings associated with these lesions. Colonic polyps can be sessile or pedunculated; their appearance depends on whether they are located on the dependent or nondependent wall of the bowel. Villous tumors may be flat, lobulated lesions, also known as "carpet" lesions, that are characterized by a finely nodular or reticular surface pattern, without a discrete mass. Colonic carcinomas may manifest as plaquelike, polypoid, semiannular ("saddle") or annular lesions. Colonic neoplasms sometimes are more difficult to detect in the region of the ileocecal valve or the distal rectum or in patients with severe diverticulosis. Careful double-contrast technique and meticulous scrutiny of the images therefore are required to optimize detection of these lesions.

Barium Sulfate↗
PubMed2000

Adynamic ileus after caesarean section mimicking intestinal obstruction: findings on abdominal radiographs.

The purpose of this study was to determine the spectrum of findings and the frequency of apparent distal colonic obstruction on abdominal radiographs in women with obstructive symptoms following Caesarean section. A search of radiology files yielded 21 patients who had abdominal radiographs because of obstructive symptoms during the early post-operative period. The radiographs were reviewed retrospectively to characterize the bowel gas patterns in these patients. Medical records were also reviewed to determine the treatment and patient course. Abdominal radiographs showed findings suggestive of distal colonic obstruction in 15 patients (71%), small bowel obstruction in 2 (10%), adynamic ileus in 3 (14%) and a normal bowel gas pattern in 1 (5%). In all 15 patients with apparent distal colonic obstruction, there was minimal or no gas in the rectosigmoid, with an associated pelvic mass representing the enlarged post-partum uterus, which compressed the rectosigmoid and prevented it from filling with gas. All 21 patients had rapid clinical or radiographic improvement on conservative management, indicating a transient post-operative ileus. Radiologists should be aware of the limitations of abdominal plain radiographs following Caesarean section so that a post-operative ileus is not mistaken for a distal colonic obstruction and conservative measures can be undertaken to decompress the bowel until the ileus resolves.

Adult↗
PubMed2000

The "foamy" esophagus: a radiographic sign of Candida esophagitis.

OBJECTIVE: The purpose of this study was to describe the radiographic features of the "foamy" esophagus, a new sign of Candida esophagitis seen on double-contrast esophagography, in six patients. CONCLUSION: The foamy esophagus was characterized by innumerable tiny (1-3 mm), round lucencies (bubbles) that intermingled with the barium suspension along the top of the barium column, producing a layer of foam. Candida esophagitis should be strongly suspected when a foamy esophagus is detected on double-contrast esophagography, particularly in patients with underlying esophageal involvement by scleroderma.

Adult↗
PubMed2000

Diagnosis of primary versus secondary achalasia: reassessment of clinical and radiographic criteria.

OBJECTIVE: Our purpose was to reassess the usefulness of barium studies and various clinical parameters for differentiating primary from secondary achalasia. MATERIALS AND METHODS: Radiology files from 1989 through 1999 revealed 29 patients with primary achalasia and 10 with secondary achalasia (caused by carcinoma of the esophagus in three, of the gastric cardia in three, of the lung in three, and of the uterus in one) who met our study criteria. The radiographs were reviewed to determine the morphologic features of the narrowed distal esophageal segment and gastric cardia and fundus. Medical records were also reviewed to determine the clinical presentation; endoscopic, manometric, and surgical findings; and treatment. RESULTS: The mean patient age was 53 years in primary achalasia versus 69 years in secondary achalasia (p = 0.03). The mean duration of dysphagia was 4.5 years in primary achalasia versus 1.9 months in secondary achalasia (p <0.0001). The narrowed distal esophageal segment had a mean length of 1.9 cm in primary achalasia versus 4.4 cm in secondary achalasia (p < 0.0001), and the esophagus had a mean diameter of 6.2 cm in primary achalasia versus 4.1 cm in secondary achalasia (p <0.0001). The narrowed segment was eccentric or nodular or had abrupt proximal borders in only four of 10 patients with secondary achalasia, and evidence of tumor was present in the gastric fundus in only three. CONCLUSION: When findings of achalasia are present on barium studies, a narrowed distal esophageal segment longer than 3.5 cm with little or no proximal dilatation in a patient with recent onset of dysphagia should be considered highly suggestive of secondary achalasia, even in the absence of other suspicious radiographic findings.

Adult↗
PubMed2000

Small flat umbilicated tumors of the colon: radiographic and pathologic findings.

OBJECTIVE: We describe the radiographic and pathologic findings of small flat umbilicated tumors of the colon detected on double-contrast barium enema examinations performed in a Western population. CONCLUSION: Unlike those reported by Japanese authors, the small flat umbilicated tumors of the colon in our patients were usually hyperplastic polyps, previously called "inverted hyperplastic polyps." Nevertheless, colonoscopy with excisional biopsy is warranted for such tumors detected on double-contrast barium enema examinations because of the small possibility that these tumors represent adenoma or even early adenocarcinoma.

Aged↗