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Biomedical subjects

H Herlinger

Publications and source records attributed to H Herlinger.

At least 19 recordsLinked to original sources
PubMed1995

Colon cancer: morphology detected with barium enema examination versus histopathologic stage.

PURPOSE: To determine the relationship between the morphology of colon carcinomas detected with barium enema examination and the cancer stage. MATERIALS AND METHODS: Clinical, radiographic, endoscopic, surgical, and histopathologic findings were retrospectively reviewed in 152 patients with colon cancer detected with barium enema examination during a 2-year period. RESULTS: Eighty-six patients (57%) had lesions in the rectum and sigmoid and descending colon, and 66 (43%) patients had lesions more proximally in the colon. Lesions on the right side of the colon were less likely to cause symptoms than those on the left side. Eighty-one patients (53%) had annular or semiannular lesions, 57 (38%) had polypoid lesions, and 14 (9%) had plaquelike or carpet lesions. Six patients (4%) had Dukes stage A lesions; 84 (55%), Dukes stage B lesions; 42 (28%), Dukes stage C lesions; and 20 (13%), Dukes stage D lesions. CONCLUSION: Annular or semiannular carcinomas had higher rates of serosal invasion and lymph node metastasis than polypoid carcinomas, but the rates of liver metastases were comparable.

Adenocarcinoma↗
PubMed1995

Guide to imaging of the small bowel.

The small intestine is a difficult organ to image. Its considerable length, the changing location of its many overlapping coils, and the often adverse effect of luminal fluids on the coating ability of barium necessitate the use of special techniques employing special barium formulations.

Barium Sulfate↗
PubMed1992

Cytomegalovirus gastritis: protean radiologic features.

Infection with cytomegalovirus (CMV) is a major feature of acquired immunodeficiency syndrome (AIDS). Gastrointestinal involvement is being seen more frequently. Our collective experience involves nine patients with stomach involvement. Seven patients were intravenous drug abusers or homosexuals with AIDS. One developed CMV gastritis as a complication of leukemia and one patient was a West African with lymphoma and human immunodeficiency virus (HIV) infection. All our patients had biopsy-proven CMV inclusion bodies. The radiographic appearances varied widely. The findings included markedly thickened edematous folds, erosive gastritis with aphthous ulceration, and superficial and deep ulceration. One patient had deep ulceration with fistula formation. Computed tomographic (CT) scans confirmed the greatly thickened gastric wall and coarsened folds in two patients. Associated gastrointestinal infections included candida and herpes, and, in addition, pneumocystis carinii pneumonia (PCP) was present in two patients. CMV gastritis may mimic several other conditions including erosive gastritis, peptic ulceration, lymphoma, and carcinoma. It should be strongly considered in immunosuppressed patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Focal spiculation of the upper thoracic esophagus: normal variant at double-contrast esophagography.

A review of 100 routine biphasic upper gastrointestinal examinations revealed focal spiculation of the upper thoracic esophagus as a transient finding in 11 patients (11%) who otherwise had no clinical or radiographic signs of esophageal disease. All 11 patients had remarkably similar findings, with thin (1-2 mm wide), transverse folds or striations above the level of the aortic arch, producing a spiculated or serrated appearance in profile. This focal spiculation should be considered a normal variant in the esophagus on double-contrast radiographs. It is suspected that this phenomenon is related to weakening of peristalsis or localized contraction of the longitudinally oriented muscularis mucosae at the junction of the striated- and smooth-muscle portions of the esophagus. Whatever the explanation, radiologists should be familiar with this finding, so that it is not mistaken for a focal area of esophagitis.

Adolescent↗
PubMed1991

Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients.

Initial observation and evaluation of patient progress have reduced the number of operative interventions in the management of small intestinal obstruction. The differentiation of simple mechanical from strangulating obstructions has remained difficult. Strangulation is not an invariable component of a closed loop obstruction. We report 27 patients with small bowel obstruction initially managed nonsurgically, in whom enteroclysis 2-8 days after admission demonstrated unsuspected closed loop obstruction. In 25 of the 27 patients, subsequent surgery confirmed the radiologic diagnosis: all the obstructed loops were viable and there was no operative mortality. Our experience suggests that the early performance of enteroclysis should be considered in patients with small bowel obstruction undergoing a trial of nonoperative management.

Adolescent↗
PubMed1991

Radiologic features of closed loop obstruction: analysis of 25 confirmed cases.

The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.

Adolescent↗
PubMed1991

Giant, human immunodeficiency virus-related ulcers in the esophagus.

Human immunodeficiency virus (HIV) infection of the esophagus has recently been implicated as a cause of giant esophageal ulcers in HIV-positive patients with odynophagia. The authors examined four patients in whom esophagograms (one single-contrast and three double-contrast studies) revealed giant, HIV-related ulcers indistinguishable from those of cytomegalovirus (CMV) esophagitis. All four patients had severe odynophagia, one had an associated maculopapular rash, and two became HIV-positive at approximately the time of clinical presentation. In all patients, biopsy samples, brushings, and cultures obtained with endoscopy were negative for CMV or herpes simplex. One patient had positive brushings for candidiasis, but this may have resulted from fungal superinfection of the ulcer. Two patients were treated with orally administered steroids, and all four had swift clinical improvement; symptoms disappeared during an average period of 8.3 days from presentation. HIV-related esophageal ulcers should be distinguished from CMV ulcers, so that appropriate treatment can be initiated in these patients.

Adult↗
PubMed1991

Diagnosis of pneumoperitoneum on supine abdominal radiographs.

A blinded, retrospective study was performed to determine the value of supine abdominal radiographs in diagnosing pneumoperitoneum. Supine films from 44 cases of pneumoperitoneum were randomly interspersed among supine films from 87 control subjects without free air, and the films were reviewed for the presence or absence of various signs of pneumoperitoneum, including Rigler's sign (gas on both sides of the bowel wall), the falciform ligament sign (gas outlining the falciform ligament), the football sign (gas outlining the peritoneal cavity), the inverted-V sign (gas outlining the medial umbilical folds), and the right-upper-quadrant gas sign (localized gas in the right upper quadrant). One or more of these signs were present in 26 cases (59%) of pneumoperitoneum, including the right-upper-quadrant gas sign in 18 cases (41%), Rigler's sign in 14 cases (32%), and the falciform ligament and football signs in one case each (2%). Unfortunately, there were frequent errors in the interpretation of the right-upper-quadrant gas sign and Rigler's sign, with a total of 11 false-positive cases (13%). Further analysis of the true-positive right-upper-quadrant gas signs showed that these gas collections were always triangular or linear with an inferolateral to superomedial orientation and, if triangular, a concave superolateral border. In the true-positive Rigler's signs, the bowel wall thickness ranged from 1 to 8 mm, whereas the false positives all had a bowel wall thickness of 1 mm or less. Proper interpretation of the various signs of pneumoperitoneum on supine films should lead to more accurate diagnosis of this condition.

False Positive Reactions↗
PubMed1991

Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation.

Total gastrectomy and esophagojejunostomy is an increasingly common operation that is associated with a variety of early and late postoperative complications. Between 1980 and 1990, 26 patients at our hospital who underwent this surgery (19 Roux-en-Y esophagojejunostomies and seven loop esophagojejunostomies) had postoperative upper gastrointestinal studies with water-soluble contrast material or barium. The studies were performed during the early postoperative period (within 30 days after surgery) in seven patients, the late postoperative period (more than 30 days after surgery) in seven patients, or both in 12 patients. Five patients (19%) had anastomotic leaks, four involving the esophagojejunal anastomosis and one the blind-ending jejunal limb. Five patients (19%) had transient narrowing of the esophagojejunal anastomosis during the early postoperative period, probably due to acute postoperative edema and spasm. Six patients (23%) had narrowing of the esophagojejunal anastomosis during the late postoperative period due to anastomotic strictures (three patients) or recurrent tumor (three patients). Alkaline reflux esophagitis was found in three (43%) of seven patients who had a loop esophagojejunostomy. However, two (11%) of 19 patients with a Roux-en-Y esophagojejunostomy had relatively long strictures in the distal esophagus, apparently due to scarring from alkaline reflux esophagitis. Two patients (8%) had an afferent loop obstruction due to metastatic tumor and postsurgical scarring. Radiologists need to be familiar with the normal postoperative radiologic appearances and the radiologic findings of early and late complications associated with this procedure.

Adult↗
PubMed1990

Isolated gastric varices: splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.

Diagnosis, Differential↗
PubMed1990

Non-Hodgkin lymphoma of the small intestine.

The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.

Adult↗
PubMed1990

Scirrhous carcinoma of the stomach: radiologic and endoscopic diagnosis.

During a recent 10-year period, scirrhous tumors of the stomach were diagnosed at upper gastrointestinal examinations in 27 patients in whom pathologic correlation was available. Nineteen patients underwent double-contrast studies, and eight underwent single-contrast studies. Twenty-two of the 27 patients had primary gastric carcinoma, four had gastric involvement by metastatic breast cancer, and one had antral gastritis and scarring without evidence of malignancy. Although the involved gastric segment often demonstrated only mild loss of distensibility, the presence of a scirrhous tumor was suggested radiographically by distortion of the normal surface pattern of the stomach with mucosal nodularity, spiculation, ulceration, and/or thickened, irregular folds. Ten patients had localized lesions involving the gastric fundus and/or body rather than the classic form of linitis plastica involving the distal stomach. Furthermore, endoscopy had significant limitations in confirming this diagnosis, as findings from brushings or biopsies were positive for malignancy in only 14 of 20 patients (70%). Radiologists should be aware of the frequent proximal location of these scirrhous tumors and of the problems of endoscopic diagnosis.

Adenocarcinoma, Scirrhous↗