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Biomedical subjects

S E Rubesin

Publications and source records attributed to S E Rubesin.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2000

Giant hyperplastic polyps in the stomach: radiographic findings in seven patients.

OBJECTIVE: We reassessed the radiographic findings of giant hyperplastic polyps in the stomach on double-contrast upper gastrointestinal examinations in seven patients. CONCLUSION: Giant hyperplastic polyps in the stomach may be manifested by distinctive findings on double-contrast barium studies, appearing as polypoid lesions with multiple lobulated components that form a conglomerate mass. Nevertheless, endoscopy and biopsy are required to rule out a polypoid carcinoma as the cause of these findings.

Aged↗
PubMed2000

Portal hypertensive gastropathy: radiographic findings in eight patients.

OBJECTIVE: The purpose of our study was to determine the findings of portal hypertensive gastropathy on barium studies in eight patients and whether there are useful radiographic criteria for diagnosing this condition. CONCLUSION: Our experience suggests that portal hypertensive gastropathy may manifest on barium studies as thickened nodular folds in the gastric fundus. Although varices or various forms of gastritis can also produce thickened gastric folds, portal hypertensive gastropathy should be suspected when this finding is detected in patients with known portal hypertension.

Barium Sulfate↗
PubMed1999

Imaging modalities in inflammatory bowel disease.

This article provides an in-depth review of the radiologic and endoscopic imaging techniques used in the evaluation and management of inflammatory bowel disease (IBD). The use of imaging studies to diagnose IBD and to differentiate ulcerative colitis from Crohn's disease is discussed. The evaluation of suspected complications associated with IBD, including strictures and fistulous disease, as well as surveillance for colorectal cancer are also addressed.

Acute Disease↗
PubMed1999

Tumorous gastric varices: radiographic findings in 10 patients.

PURPOSE: To determine the appearance of tumorous gastric varices on double-contrast barium studies and whether these varices have characteristic radiographic features. MATERIALS AND METHODS: Review of radiology files revealed 86 patients with gastric varices diagnosed during double-contrast upper gastrointestinal tract examinations. Of these 86 patients, 12 (14%) had a conglomerate mass of varices, or tumorous varices. Five of the 12 patients had proved gastric varices and five were presumed to have varices on the basis of additional diagnostic test results, clinical follow-up findings, or both. Radiographs from these 10 patients were reviewed retrospectively to determine the size, location, and morphologic features of these lesions. RESULTS: Tumorous varices had a mean size of 6.8 cm (range, 3-11 cm). They involved the posteromedial border of the gastric fundus in eight patients, the central cardiac region in one, and the anterolateral-inferior fundal border in one. Viewed in profile, the varices appeared as smooth submucosal masses with undulating contours and discrete borders. Viewed en face, the varices manifested as a conglomerate of thickened, tortuous folds that faded peripherally into the adjacent mucosa. CONCLUSION: Tumorous gastric varices manifest as remarkably similar findings on double-contrast barium studies, usually appearing en face as a conglomerate of thickened, lobulated folds and in profile as smooth, undulating, submucosal masses on the posteromedial border of the gastric fundus. It is important to be aware of the characteristic features of tumorous gastric varices on double-contrast studies so that they are not mistaken for neoplastic lesions in the stomach.

Adult↗
PubMed1999

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients.

PURPOSE: To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. MATERIALS AND METHODS: A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. RESULTS: All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. CONCLUSION: A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.

Adult↗
PubMed1998

Value of digital fluoroscopy for the diagnosis of pneumatosis coli.

Two cases are presented of benign pneumatosis coli diagnosed on digital fluoroscopic barium enema examinations, in which the gas-filled cysts in the colonic wall were only recognized by postprocessing of the images (i.e. increasing the brightness and contrast settings) at the computer workstation. When digital barium enemas are performed, we therefore recommend image postprocessing to evaluate polypoid lesions in order to differentiate pneumatosis coli from true colonic neoplasms.

Aged↗
PubMed1998

Gastric mucosa-associated lymphoid tissue lymphoma: radiographic findings in six patients.

PURPOSE: To determine the radiographic findings of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma on double-contrast upper gastrointestinal studies. MATERIALS AND METHODS: Pathology records, double-contrast upper gastrointestinal studies, and medical records of six patients with gastric MALT lymphoma were retrospectively reviewed. RESULTS: The most common clinical findings at presentation included epigastric pain (n = 6), dyspepsia (n = 4), and nausea and vomiting (n = 4). Double-contrast studies revealed rounded, often confluent nodules of varying size in four patients with low-grade MALT lymphoma. Nodularity was located in the gastric antrum (n = 2), body (n = 1), or body and fundus (n = 1). A fifth patient had a malignant-appearing 1-cm-diameter antral ulcer, and a sixth had a 10-cm-diameter polypoid, ulcerated mass in the gastric fundus. The latter patient was found to have high-grade MALT lymphoma with low-grade MALT lymphoma abutting the tumor. Five patients had associated Helicobacter pylori gastritis. Five patients had stage I disease, and one had stage IIB disease. At endoscopic follow-up (n = 4), marked regression of tumor occurred after treatment with antibiotics, chemotherapy, and/or radiation therapy. CONCLUSION: When low-grade MALT lymphoma is suspected on the basis of barium study results, endoscopic biopsy specimens should be obtained for a definitive diagnosis so these patients can be treated before the development of high-grade gastric lymphoma.

Aged↗
PubMed1998

Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT.

OBJECTIVE: The purpose of the study was to develop quantitative and qualitative criteria for diagnosing fatty liver on contrast-enhanced helical CT. SUBJECTS AND METHODS: Differential liver-spleen attenuation was evaluated between 80 and 120 sec after injection in 76 patients who underwent contrast-enhanced helical CT. Unenhanced CT images had earlier established fatty liver when the liver minus spleen attenuation difference was less than or equal to -10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presence of geographic areas spared from fatty infiltration, and the relative liver-spleen attenuation. The diagnostic accuracies of various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS: Sensitivity, specificity, and receiver operating characteristic curve areas for observers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differential liver-spleen attenuation (80-100 sec; -20.5 H discriminatory value), the values were 86%, 87%, and .94, respectively; and for quantitative differential liver-spleen attenuation (101-120 sec; -18.5 H discriminatory value), the values were 93%, 93%, and .98, respectively. Differential liver-spleen attenuation was time-dependent; overlap was noted between healthy subjects and patients with fatty liver. Qualitatively, geographic sparing was highly specific (94%) for fatty liver, whereas liver attenuation greater than or equal to spleen attenuation excluded fatty liver in all but one case. CONCLUSION: Although quantitative and qualitative criteria for diagnosing fatty liver on helical CT can be determined, they are protocol-specific. Limited unenhanced hepatic CT remains the optimal technique for detection of fatty infiltration of the liver.

Contrast Media↗
PubMed1998

Hartmann's pouch: radiographic evaluation of postoperative findings.

OBJECTIVE: The purpose of this study was to determine the usefulness of contrast-enhanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities. MATERIALS AND METHODS: We performed a retrospective study of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year period. Sixty-four patients underwent single-contrast barium studies of the pouch, 17 underwent studies with a water-soluble contrast medium, and three underwent both types of studies. The radiographic studies were reviewed to determine the types and frequency of abnormalities involving the pouch. Medical records were also reviewed to determine clinical presentation and course. RESULTS: Abnormalities of the Hartmann's pouch were detected on contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine contrast-enhanced radiography of the pouch, 11 (16%) had abnormalities, including diversion colitis in three, leaks in two, adhesions in two, recurrent carcinoma in two, ulcerative colitis involving the pouch in one, and a stricture in one. In both patients with clinically silent leaks, the contrast-enhanced radiography was performed 3 months or more after creation of the pouch. Of the remaining 14 patients who underwent contrast-enhanced radiography because of suspected complications involving the pouch, five (36%) had abnormalities revealed, including leaks in two, fistulas in two, and recurrent carcinoma in one. CONCLUSION: Contrast-enhanced radiography of the Hartmann's pouch revealed abnormalities of the pouch in 19% of patients, including leaks or fistulas, diversion colitis, adhesions, strictures, and recurrent tumor. Because two patients had clinically silent leaks that were detected during the late postoperative period, it may be prudent to perform these studies with a water-soluble contrast medium to avoid the problems associated with extravasation of barium into the extra- or intraperitoneal spaces.

Adolescent↗
PubMed1997

Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis.

OBJECTIVE: The purpose of this study was to determine the sensitivity of barium studies in revealing carcinoma of the esophagus and esophagogastric junction. MATERIALS AND METHODS: We retrospectively reviewed 50 cases of squamous cell carcinoma of the esophagus (n = 25) and adenocarcinoma of the esophagus (n = 14) or esophagogastric junction (n = 11) in which double-contrast (n = 46) or single-contrast (n = 4) barium studies had been done. The original radiology reports were reviewed to determine whether the lesions had been seen on barium studies and whether cancer had been diagnosed. Records were also reviewed to determine the number of patients who underwent esophageal endoscopy because of findings suggestive of cancer on barium studies at some point from January 1992 through December 1992. Pathology records were then reviewed to determine the number of true- and false-positive barium studies during this same period. RESULTS: Lesions were shown on barium studies in 49 (98%) of 50 patients, and carcinoma of the esophagus or esophagogastric junction was diagnosed or suspected in 48 patients (96%). In a separate part of the study, we found that endoscopy had been recommended to rule out malignant tumor in only 26 (1%) of 2484 patients who underwent barium studies at some point from January 1992 through December 1992. Endoscopy revealed cancer in 11 of those 26 patients; the remaining 15 were assumed to have false-positive radiologic examinations. Barium studies therefore had a positive predictive value of 42%. CONCLUSION: The double-contrast barium study is a sensitive technique for the diagnosis of carcinoma of the esophagus and esophagogastric junction. This high sensitivity can be achieved while recommending endoscopy in only about 1% of all patients who undergo barium studies.

Adenocarcinoma↗
PubMed1997

Acute radiation esophagitis: radiographic findings.

OBJECTIVE: The purpose of this study was to assess the findings of acute radiation esophagitis in patients who undergo double- and single-contrast esophagograms and, specifically, to evaluate the presence or absence of a granular mucosa in these patients. MATERIALS AND METHODS: We retrospectively reviewed the radiographic findings in 13 patients with acute radiation esophagitis who underwent double-contrast (n = 8) or single-contrast (n = 5) esophagograms at our hospital between 1988 and 1996. The barium studies were obtained 13-87 days (average, 39 days) after the initiation of radiation therapy because of acute odynophagia, dysphagia, or both. RESULTS: Of the 13 patients with acute radiation esophagitis, the upper thoracic esophagus was involved in three patients, the mid esophagus in four, the distal esophagus in four, and the mid and distal esophagus in two. Of the eight patients who underwent double-contrast esophagograms, three (37%) had multiple small, discrete ulcers; four (50%) had a distinctive granular appearance of the mucosa; and one (13%) had both. In all eight patients, this ulceration or granularity was associated with variable esophageal narrowing within a known radiation portal. Of the five patients who underwent single-contrast esophagograms, two had esophageal narrowing, one had narrowing and ulceration, and two had thickened folds. Of the four patients who also underwent follow-up barium studies, three developed radiation strictures at the site of the previous injury. CONCLUSION: In patients with acute radiation esophagitis, double-contrast esophagograms may reveal a variable segment of esophageal narrowing with multiple discrete ulcers or a distinctive granular appearance of the mucosa within a known radiation portal. In the appropriate clinical setting, the diagnosis should be suggested by this constellation of findings.

Acute Disease↗
PubMed1995

Giant ulcers of the esophagus in patients with human immunodeficiency virus: clinical, radiographic, and pathologic findings.

PURPOSE: To determine the causes of giant esophageal ulcers in patients with human immunodeficiency virus (HIV) and whether clinical or radiographic criteria can be used to differentiate the infections that cause these ulcers. MATERIALS AND METHODS: From January 1990 through December 1993, giant esophageal ulcers ( > or = 1 cm in diameter) were found in 21 HIV-positive patients (19 men and two women 23-66 years of age; mean, 39 years). The radiographic findings were reviewed and correlated with clinical, endoscopic, and pathologic findings. RESULTS: In 16 patients, the ulcers were caused by HIV, in three by cytomegalovirus (CMV), and in two by CMV and HIV. The clinical and radiographic findings were the same for the two types of ulcers. However, HIV ulcers responded to treatment with steroids, and CMV ulcers responded to treatment with ganciclovir. CONCLUSION: It is not possible to differentiate HIV from CMV ulcers on the basis of clinical or radiographic criteria; thus, endoscopy is necessary for a definitive diagnosis.

AIDS-Related Opportunistic Infections↗